198600539-6-11-2024-28-AS-RORN-D6KTAB-20240625143316

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198600539
Report Date: 06/11/2024
Date Signed: 06/11/2024 04:01:37 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/25/2023 and conducted by Evaluator Jose Villalobos

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20230425093918

FACILITY NAME:	PICO RIVERA GARDENS		FACILITY NUMBER:	198600539
ADMINISTRATOR:	MEIR SHAUL YITZI TEICHMAN		FACILITY TYPE:	735
ADDRESS:	6525 ROSEMEAD BLVD.		TELEPHONE:	(562) 949-8489
CITY:	PICO RIVERA	STATE: CA	ZIP CODE:	90660
CAPACITY:	185	CENSUS: 137	DATE:	06/11/2024
		UNANNOUNCED	TIME BEGAN:	09:31 AM
MET WITH:	Administrator Tony Olmos		TIME COMPLETED:	04:10 PM

ALLEGATION(S):

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Facility staff are not ensuring that residents have access to water.
Facility staff are not ensuring that the air conditioner is functional.
Facility staff are not ensuring that the residents receive a variety of foods.
Facility staff are not ensuring that the facility is maintained clean.
Facility staff are not ensuring that the facility is free of pests.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jose Villalobos conducted a subsequent visit to investigate the allegation listed above. LPA met with Administrator Tony Olmos and the purpose of the visit was discussed.

On 4/25/23 LPA Villalobos conducted the following: LPA Villalobos interviewed Staff #1-#3 (S1-S3) and interviewed clients #1-8 (C1-C8). LPA toured the physical plant and observed the food supply. LPA collected documents such as: the food menu for the last three (3) weeks, physicians report for C1 , needs and services for C1, LIC 601 for C1 , Staff and Client Roster , Pest Control Services Reciepts , Maintenance logs for month of March and April. As of today, LPA Villalobos has also interviewed Staff #4-#6 (S4-S6) and Clients #9-#13 (C9-C13), reviewed addition food menu for the past month, and did an additional tour of the physical plant to include the following client rooms: 11, 12, 15, 32, 41, 58, 60,61, 107, 204, and 220.

The investigation revealed the following:
Continued on LIC 9099-C

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Jose Villalobos
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 06/11/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 1 of 3

Control Number 28-AS-20230425093918

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: PICO RIVERA GARDENS	FACILITY NUMBER: 198600539
	VISIT DATE: 06/11/2024

NARRATIVE

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In regards to the allegation "Facility staff are not ensuring that residents have access to water" it was alleged that the facility was not providing water to the clients in care. (6) of (6) Staff interviewed denied the allegation. (13) of (13) Clients interviewed could not corroborate the allegation. Initial details provided stated that on 4/25/23 the facility did not have water and was not providing water to clients when they asked for it. Interviews with staff and clients does not show any knowledge of there being no water in the facility or clients being refused water. LPA observed the water to be functioning in client rooms inspected as well as there being a water container for drinking available to all clients near the medication room. File review does not show there were any issues regarding water availability in the facility for the dates provided to LPA. Based on interviews, observations and file review conducted; although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated.

In regards to the allegation "Facility staff are not ensuring that the air conditioner is functional." it was alleged that room #41 is hot and the air conditioning is not working. (6) of (6) Staff interviewed denied the allegation. (13) of (13) Clients interviewed could not corroborate the allegation. Staff interviewed denied knowledge of the air conditioning not working in the facility which included room #41. LPA Villalobos did not observe issues with the air conditioning in the facility and room #41 during the Initial visit conducted. Clients interviewed were not aware of there being issues with the air conditioning of the facility back in April 2023 nor any current issues. LPA observed during the subsequent visit that the facility and rooms toured were at a comfortable temperature as the AC was operational. File review did not show that there was an issue with the facility air conditioner early 2023. Based on interviews, observations and file review conducted; although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated.

In regards to the allegation "Facility staff are not ensuring that the residents receive a variety of foods" it is alleged that the facility provides the same meals every week and there are no vegetarian meals. (6) of (6) Staff interviewed denied the allegations. (10) of (13) Clients interviewed could not corroborate the allegation. Interviews show that the facility has a food menu that repeats monthly and not weekly. Interviews added that clients are able to request specific meals from the staff if asked ahead of time. There are vegetarian meals available when requested and no one is forced to eat meals that contain meat. (3) Clients interviewed expressed a want for specific meals to be listed on the menu.....

Continued on LIC 9099-C

NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Jose Villalobos
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 06/11/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 28-AS-20230425093918

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: PICO RIVERA GARDENS	FACILITY NUMBER: 198600539
	VISIT DATE: 06/11/2024

NARRATIVE

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File review shows that the food menu has a 4 week cycle. Within those 4 weeks no days share the same food menu. Review of the menu shows that there is a variety of meals provided. LPA observed a food supply of items from all food groups. Based on interviews, observations and file review conducted; although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated.

In regards to the allegation "Facility staff are not ensuring that the facility is maintained clean" it is alleged that the facility is dirty and staff do not clean. (6) of (6) Staff interviewed denied the allegation. (13) of (13) Clients interviewed could not corroborate the allegation. Detail provided to LPA was that the clients in care were spilling coffee repeatedly and it was not cleaned. Interviews conducted show that every morning there is a coffee time where clients arrive to the kitchen to grab coffee. Some clients will walk back to their rooms and spill coffee in the hallways. Interviews show that staff are aware this happens daily and so they will clean the hallways everyday after the coffee time as well as in the afternoon and overnight. During LPA's initial and subsequent visit, staff were observed to be mopping the hallways and cleaning any mess left by the clients in care. Based on interviews, observations and file review conducted; although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated.

In regards to the allegation "Facility staff are not ensuring that the facility is free of pests" it is alleged that there are pests in C1's room. (6) of (6) Staff interviewed denied the allegation. (13) of (13) Clients interviewed could not corroborate the allegation. Interviews did not show any knowledge of there being pests in C1's room. LPA did not observe any pests in C1's room during the initial visit on 4/25/23 and as of today C1 is no longer in the facility for LPA to follow up on. File review shows that the facility has recurring pest control services in the facility. The notes provided to LPA all list the services conducted by the pest control but do not state whether live pests are found in the facility and in client rooms. During todays tour, LPA did not observe any pests in the facility or in the client rooms entered. Clients interviewed stated the facility staff address issues of pests when they are informed about them. Based on interviews, observations and file review conducted; although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated.

Exit interview conducted and a copy of this report was provided.

NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Jose Villalobos
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 06/11/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2024

LIC9099 (FAS) - (06/04)

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