198600539-7-8-2024-28-AS-FFIS-D7B2XX-20240718174751

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198600539
Report Date: 07/08/2024
Date Signed: 07/08/2024 03:02:14 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
04/24/2023 and conducted by Evaluator Jose Villalobos

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20230424115239

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: 136	DATE:	07/08/2024
		UNANNOUNCED	TIME BEGAN:	08:10 AM
MET WITH:	Administrator Tony Olmos		TIME COMPLETED:	03:10 PM

ALLEGATION(S):

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Drug activity on the premises
Facility has an infestation of insects
Facility is unclean
Staff threatened to evict resident
Staff failed to provide a safe and comfortable environment for residents
Facility is in disrepair
Staff mismanaged residents' medication

INVESTIGATION FINDINGS:

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

Initial visit on 4/25/23 consisted of 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-C2 , needs and services for C1-C2, LIC 601 for C1-C2 , Staff and Client Roster , Pest Control Services Reciepts for April 2023, Maintenance logs for month of March and April 2023, and file for staff #4. As of today LPA has toured rooms numbers: 11, 12, 28, 32, 41, 46, 48, 49, 54, 55, 58, 60, 61, 107, 204, and 220. LPA attempted to reinterview C1 and C2 but they are no longer clients of the facility and are unavailable for interview. LPA interviewed Clients #9-#13 (C9-C13) and Staff #4-#5 (S4-S5). LPA collected documents regarding medication records for C1. 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: 07/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2024

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 4

Control Number 28-AS-20230424115239

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: 07/08/2024

NARRATIVE

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In regards to the allegation "Drug activity on the premises" it is alleged that there is drug activity all over the facility. (5) of (5) Staff interviewed denied the allegation. (11) of (13) Clients interviewed could not corroborate the allegation. Interviews stated that it is possible there are clients who use drugs outside the premises. Staff interviewed stated they had not observed anyone use drugs inside the facility. Clients go out and will smell like they have smoked marijuana when they return. Interviews added that sometimes the smells come from rooms but clients have not been caught with them. During LPA's tour of the facility on both 4/25/23 and 7/8/24, there was no smell of drugs LPA could distinguish. LPA did not observe drugs in the rooms entered throughout this investigation. Based on interviews, observations and file review; 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 has an infestation of insects" it is alleged that there is a roach and bed bug infestation in the facility. (5) of (5) Staff interviewed denied the allegation. (11) of (13) Clients interviewed could not corroborate the allegation. Facility stated that they have maintained a constant contract with a pest control company to provide services to the building and all the rooms repeatedly through the years. If anyone ever informs the staff of observing pests, the staff will address it and not ignore it. LPA was provided with information that rooms #28, 53 and 61 were infested with pests. LPA observed room 28 and 61 during the investigation and did not observe roaches or bed bugs. Client in room #53 refused LPA entry so LPA was unable to make an observation of that room. File review does show that the facility maintains pest control services for treatments. There are no notes of live pests being found on the pest control invoices. Based on interviews, observations and file review; 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 is unclean" it alleged that facility staff do not clean the facility because it is sticky. (5) of (5) Staff interviewed denied the allegation. (12) of (13) Clients interviewed could not corroborate the allegation. Staff interviewed stated that the floors get sticky down the hallways after coffee is served. That is because the clients will spill it as they walk around. It is a common occurrence and staff will always mop the hallways daily. The stickiness is not ignored and it cleaned up daily. Clients interviewed confirmed to see staff moping the hallways daily. LPA observed staff cleaning rooms and the hallways during the visits. Based on interviews, observations and file review; 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.
Continued on LIC 9099-C

NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Jose Villalobos
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 07/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 28-AS-20230424115239

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: 07/08/2024

NARRATIVE

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In regards to the allegation "Staff threatened to evict resident" it is alleged that S2 would threaten to evict C1. (5) of (5) Staff interviewed denied the allegation. (12) of (13) Clients interviewed could not corroborate the allegation. Details provided stated that S2 would threaten to evict C1 if C1 kept reporting issues in the facility. S2 denied that ever happening. Staff interviewed were not aware of S2 ever threatening C1 with eviction. File review does not show any documentation of an eviction notice ever being provided to C1. File review did show that C1 moved out on 3/25/24. Based on interviews, observations and file review; 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 "Staff failed to provide a safe and comfortable environment for residents" it is alleged that the facility rooms and common rooms are too hot and uncomfortable for clients in care. (5) of (5) Staff interviewed denied the allegation. (12) of (13) Clients interviewed could not corroborate the allegation. Staff interviewed denied that the facility is too hot for clients in care. Staff interviews stated that if they are aware of issues with the temperature in the rooms, the staff will look into what the causes are. If rooms are having issues with the AC system, then repairs on worked on right away. LPA toured the physical plant and observed the facility to be a comfortable temperature. Based on interviews, observations and file review; 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 is in disrepair" it is alleged that the air conditioning was broken in the facility and the activity room tvs were broken. (5) of (5) Staff interviewed denied the allegation. (12) of (13) Clients interviewed could not corroborate the allegations. LPA toured the physical plant and did not observe the air conditioning to be in disrepair. The facility and rooms entered were at cool temperatures. LPA observed the TV's in both the activity rooms to be working. LPA observed clients using (1) of the (2) TVs in place for client use. Staff interviewed denied knowledge of the tvs ever being broken. Based on interviews, observations and file review; 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.

Continued on LIC 9099-C

NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Jose Villalobos
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 07/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2024

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 28-AS-20230424115239

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: 07/08/2024

NARRATIVE

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In regards to the allegation "Staff mismanaged residents' medication" it is alleged that C1 was not provided their medication as prescribed. (5) of (5) Staff interviewed denied the allegation. (12) of (13) Clients interviewed could not corroborate the allegation. Details provided stated that C1's medication orders were not followed for the month of February 2024 as they went 2 weeks without their blood pressure medication. C1 is no longer a client of the facility and there are no medications on site for LPA to observe. LPA was able to conduct a file review of the medication administration record (MAR) for the month of February 2024. File review does not show that C1 missed their blood pressure medication for the month for any day other than 2/18/24. The notes on file state that C1 refused their morning medication. Medication was discharged by staff late that day. Based on interviews, observations and file review; 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: 07/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2024

LIC9099 (FAS) - (06/04)

Page: 4 of 4