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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198600539
Report Date: 06/19/2024
Date Signed: 06/19/2024 02:26:35 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
06/18/2024 and conducted by Evaluator Erik Zaragoza
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20240618090554
FACILITY NAME:PICO RIVERA GARDENSFACILITY NUMBER:
198600539
ADMINISTRATOR:SANTOS DOMINGUEZFACILITY TYPE:
735
ADDRESS:6525 ROSEMEAD BLVD.TELEPHONE:
(562) 949-8489
CITY:PICO RIVERASTATE: CAZIP CODE:
90660
CAPACITY:185CENSUS: 138DATE:
06/19/2024
UNANNOUNCEDTIME BEGAN:
11:05 AM
MET WITH:Tony Olmos - AdministratorTIME COMPLETED:
02:30 PM
ALLEGATION(S):
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Facility staff do not treat clients with dignity or respect
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Erik Zaragoza conducted an initial complaint visit to investigate the allegation listed above. LPA met with Tony Olmos, administrator for the facility, and explained the purpose of the visit.

The investigation consisted of the following:LPA interviewed clients #1 - 15 (C1 - C15), Staff #1 - 5 (S1 - S5), and also obtained the staff and client roster, along with the Physician's Report, Preplacement Appraisal, the most recent Appriasal/Needs and Service Plan for C1, and also the Identification and Emergency Information Sheet for C1.

The investigation revealed the following: In regards to the allegation "Facility staff do not treat clients with dignity or respect," it is alleged that S1 has been making inappropriate comments towards C1 and threatening them, which is making C1 feel unsafe and uncomfortable living in the facility.
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Erik Zaragoza
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2024
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 2
Control Number 28-AS-20240618090554
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: 06/19/2024
NARRATIVE
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During interviews with the clients, fourteen (14) out of fifteen (15) interviewed did not corroborate the allegation. One of the clients interviewed stated that S1 is very kind and respectful to all of the other clients within the facility and has never threatened or been disrespectful to anyone in the facility. Another client interviewed stated that they think S1 is an exceptional worker and is always doing their best to assist the clients in the facility. During interviews with the staff members, five (5) out of (5) interviewed did not corroborate the allegation. During an interview with S1, they stated that they make sure to treat C1 and all other clients with dignity and respect as it is required in their work. Another staff interviewed stated that they have never seen S1 threatening or verbally harassing C1, and that similar allegations have been made against S1 and the other staff members, however this is not true and none of the staff make any inappropriate comments towards the clients.

Based on statements and interviews conducted with staff, clients, review of client files and facility file records, there was not enough supportive evidence to concur with the reported allegations. 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 this report was provided.
NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Erik Zaragoza
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2