<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198600539
Report Date: 07/09/2024
Date Signed: 07/09/2024 01:45:23 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
07/02/2024 and conducted by Evaluator Noemi Galarza
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20240702120510
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:
07/09/2024
UNANNOUNCEDTIME BEGAN:
08:50 AM
MET WITH:Tony OlmosTIME COMPLETED:
12:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not safeguard resident’s belongings.
Wrongful eviction.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Galarza conducted an initial 10-Day complaint visit to investigate the above allegations. The purpose of the visit was discussed with Administrator Tony Olmos.

The investigation consisted of: LPA toured the facility common areas, with special focus on storage of R1's personal belongings. LPA observed resident (R1's) personal belongings were locked in R1's former room. LPA reviewed and obtained copies of R1's file. Staff (S1- S7) and 10 residents were interviewed.

***Narrative continues next page.
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Noemi Galarza
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2024
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-20240702120510
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: 07/09/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Allegation: Staff did not safeguard resident’s belongings. It is alleged that facility staff did not safeguard former resident's (R1's) belongings after discharge. The resident was discharged from the facility to a higher level facility on 10/1/2023. According to information obtained, R1 received 4 bags of personal belongings that belonged to another resident, therefore, R1 called the facility inquiring about their personal belongings and new Administrator Tony Olmos stated that the belongings were no longer at the facility. The resident was under the impression that the items would be kept until they were able to make arrangements for pick-up. A total of seven (7) staff were interviewed. All staff stated they did not know R1's personal belongings are still stored/locked in the room closet. Staff assumed that the belongings were taken to the storage area, when they were not picked up within 30 days after discharge. LPA inspected R1's former room, and observed that the closet door has a lock. Therefore, R1's personal belongings are being safeguarded. Staff stated that R1's public guardian is scheduled to pick up the belonging this week. A total of 10 residents were interviewed, of which one (1) resident reported that staff safeguard resident's belongings, but residents try to break into resident rooms at night to steal belongings and sell them. There is insufficient evidence to corroborate the allegation because the facility still has R1's belongings safeguarded in the room, well beyond the facility protocol of safeguarding resident's belongings 30 days from discharge date.

Allegation: Wrongful eviction. According to information obtained, resident (R1) was "kicked out" of the facility while they were hospitalized. Based on interviews conducted, resident (R1) was transported to the hospital due to medical issues, then needed skilled nursing care, and due to behavioral issues at higher level of care placement the resident was then placed on a psychiatric hold. The resident never returned to the facility and was discharged on 10/1/2023. A total of 7 staff were interviewed. Administration staff denied the allegation, and other facility staff interviewed did not have knowledge that R1 was evicted. A total of 10 residents were interviewed, all stated that R1 was not evicted. One resident stated that R1 still visits the facility. File review was completed, there was no evidence that R1 was issued an eviction notice. Therefore, the allegation cannot be supported.

Although the allegation(s) 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 was conducted with Tony Olmos. A copy of the report was issued.
NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Noemi Galarza
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2