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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198600539
Report Date: 07/30/2024
Date Signed: 07/30/2024 04:23:48 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 Erik Zaragoza
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20240620120706
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: 137DATE:
07/30/2024
UNANNOUNCEDTIME BEGAN:
08:24 AM
MET WITH:Julia Elias - Med Tech SupervisorTIME COMPLETED:
04:30 PM
ALLEGATION(S):
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Resident was sexually abused while in care
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Erik Zaragoza conducted a subsequent complaint visit to investigate the allegation listed above. LPA was met by Julia Elias, Medication Technician (Med Tech) supervisor for the facility and explained the purpose of the visit. Administrator Tony Olmos arrived shortly thereafter.

The investigation consisted of the following: During the initial visit conducted on 6/17/2024, LPA Erik Zaragoza obtained copies of of the staff and client rosters, conducted a tour of the facility, and also obtained the appraisal, physician's report, and FACE Sheet for C1. During today's visit, LPA Erik Zaragoza interviewed Clients #2 - 14 (C2 - C14), along with Staff #2 - 4 (S2 - S4). On 6/25/2024, Investigations Branch (IB) investigator Seng interviewed Client #1 (C1) and Staff #1 (S1), and also reviewed video surveillance footage for the day of the incident.
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Erik Zaragoza
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2024
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-20240620120706
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: 07/30/2024
NARRATIVE
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The investigation revealed the following: In regards to the allegation that a "Resident was sexually abused while in care," it was alleged that C1 was raped inside their bedroom on 6/19/2024. During interviews with the clients, none of them corroborated the allegation. During IB investigator Seng's visit at the facility, they reviewed video surveillance footage of C1's bedroom with S1 between the hours of 5:00 PM on 6/19/2024 until 8:00 AM on 6/20/2024, and they did not observe anyone entering their room during this span of time. During interviews with C1, C1 admitted that it is likely that they imagined this sexual abuse occurred. During LPA Erik Zaragoza's visit, none of the thirteen (13) clients interviewed corroborated the allegation that they were sexually abused or witnessed sexual abuse while in care. One of the clients interviewed stated that they have not heard or seen of any other client being sexually abused within the facility. Another client interviewed said to their knowledge, there has never been any sexual abuse occurring within the facility. During interviews with the staff, none of them corroborated that C1 or any other clients have been sexually abused while in care. One of the staff explained that they were aware of the allegation, and that after reviewing the surveillance camera footage, they determined that no one entered C1's room on the date they reported they were sexually assaulted. Another staff interviewed reiterated that this incident did not take place, and there has not been any other issues involving sexual abuse occurring within the facility.

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 allegation is 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: 07/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2