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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198600539
Report Date: 06/26/2024
Date Signed: 06/26/2024 03:12:40 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
06/20/2024 and conducted by Evaluator Luis Mora
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20240620141755
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: 136DATE:
06/26/2024
UNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Tony Olmos - AdministratorTIME COMPLETED:
03:12 PM
ALLEGATION(S):
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9
Staff did not safeguard resident's personal belongings.
Staff made inappropriate comments towards resident.
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 Olmos (Administrator) and explained the reason for the visit.

The investigation consisted of the following: LPA obtained copies of the staff and client roster. LPA interviewed Administrator and Client 1 - Client 10 (C1 - C10).

The investigation revealed the following: regarding the allegation "staff did not safeguard resident's personal belongings”, it is alleged that a radio was stolen from C1's room. Administrator stated that C1 did bring this up to their attention and that they checked the cameras and retrieve the radio from C2's room. C1 stated that that after reporting the radio missing that staff retrieved it the radio immediately. C1 stated that C1 forgot to lock the door prior to leaving out to the community. C1 will be locking the door from now on. Six out of the ten clients interviewed stated nothing has been stolen from their rooms. Three of the clients that stated something was stolen from their rooms did not report the theft to the staff.
(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: 06/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2024
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-20240620141755
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: 06/26/2024
NARRATIVE
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 Regarding the allegation "staff made inappropriate comments towards resident”, it is alleged that the administrator made inappropriate comments towards C1. Administrator denied the allegation. C1 also denied the allegation. All other clients interviewed expressed no issues with the administrator or other staff.

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: 06/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2