198600539-6-14-2024-28-AS-RORN-D6DSST-20240619140829

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198600539
Report Date: 06/14/2024
Date Signed: 06/14/2024 02:43:29 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 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
06/07/2024 and conducted by Evaluator Luis Mora

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20240607084947

FACILITY NAME:	PICO RIVERA GARDENS		FACILITY NUMBER:	198600539
ADMINISTRATOR:	SANTOS DOMINGUEZ		FACILITY TYPE:	735
ADDRESS:	6525 ROSEMEAD BLVD.		TELEPHONE:	(562) 949-8489
CITY:	PICO RIVERA	STATE: CA	ZIP CODE:	90660
CAPACITY:	185	CENSUS: 137	DATE:	06/14/2024
		UNANNOUNCED	TIME BEGAN:	08:36 AM
MET WITH:	Tony Olmost - Administrator		TIME COMPLETED:	02:57 PM

ALLEGATION(S):

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Neglect by staff resulted in resident developing scabs on his body
Staff did not meet resident’s hygiene needs
Staff did not meet resident’s incontinence needs
Staff did not ensure facility was free of bed bugs
Staff did not ensure resident was kept free of lice

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Luis Mora conducted an unannounced initial complaint visit regarding the above allegations. LPA met with Tony Olmost (Administrator) and explained the reason for the visit.

The investigation consisted of the following: LPA obtained copies of the staff and client roster, and C1’s admission agreement, physician report, appraisal/need service plan, preplacement appraisal, functional capability, and face sheet. LPA interviewed Administrator, Staff 1, and Client 1 - Client 7 (C1 - C7), and toured C1's room.

The investigation revealed the following: regarding the allegations "neglect by staff resulted in resident developing scabs on his body", "staff did not meet resident’s hygiene needs" and "staff did not meet resident’s incontinence needs”, it is alleged that C1 arrived at the hospital on 06/05/2024 with poor hygiene, soiled with urine, covered with dirt, and scabs on generalized body.

(Continued to LIC 9099-C)

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Luis Mora
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 06/14/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2024

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

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20240607084947

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: PICO RIVERA GARDENS	FACILITY NUMBER: 198600539
	VISIT DATE: 06/14/2024

NARRATIVE

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Administrator stated that this facility does not provide assistance with showering, hygiene or incontinence needs. The clients living here are independent and take care of their own activities of daily living (ADLs). Administrator and staff interviewed stated that they have encourage C1 to shower, but there has been times that C1 refuses. Clients interviewed confirm that they do not need assistance with showering, hygiene or incontinence needs. C1 stated the same and denied these allegations. Per C1's admission agreement, assistance with showering, hygiene and incontinence needs is not part of the basic services. Additionally, C1's physician report dated 04/21/2023 states that C1 is able to care for all personal needs, bathe self, dress self, care for his/her own toilet needs, and ambulate without assistance. During this visit, LPA observed C1 to be in clean state and did not smell urine coming from him.

Regarding the allegations "staff did not ensure facility was free of bed bugs" and "staff did not ensure resident was kept free of lice", it is alleged that C1 arrived at the hospital on 06/05/2024 with lice and bed bugs on the body. Administrator and staff denied these allegations and stated they have not seen bed bugs or lice on C1's body. Clients interviewed and who know C1 all stated they have not seen bed bugs or lice on C1. C1 denied these allegations. All clients interviewed including C1 stated they have not seen bed bugs in their rooms. LPA toured C1's room and did not observed any bed bugs. LPA did not observe bed bugs or lice on C1.

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are unsubstantiated.

Exit interview held and a copy of the report was provided

NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Luis Mora
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 06/14/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2024

LIC9099 (FAS) - (06/04)

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