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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198600539
Report Date: 08/01/2024
Date Signed: 08/01/2024 02:45:08 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
07/24/2024 and conducted by Evaluator Nune Margaryan
COMPLAINT CONTROL NUMBER: 28-AS-20240724145005
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: 135DATE:
08/01/2024
UNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Tony OlmosTIME COMPLETED:
02:45 PM
ALLEGATION(S):
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Illegal eviction.
Staff does not ensure facility is kept clean and sanitary.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Nune Margaryan conducted an initial complaint visit to investigate the allegations listed above. LPA was met with Assistant Administrator Tony Olmos. Administrator arrived shortly after. LPA explained the purpose of the visit.

The investigation consisted of the following: LPA Margaryan toured the facility, obtained a copy of the staff roster, client roster, Face sheet, Admission Agreement, Physician's Report, Pre-Placement Appraisal, and
Needs and Services plan for Clients #1 (C1 ), SIRs dated 10/04/2021, 12/01/2021 and 06/02/2022, Monthly discharges sheet for 07/22. LPA interviewed Administrator, Assistant Administrator, Staff 1 - Staff 3 (S1 - S3) and Client 2 - Client 14 (C2 - C14). C1 is no longer at this facility, discharged from the facility on 07/15/22.

Continue 9099C
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Nune Margaryan
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/01/2024
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-20240724145005
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: 08/01/2024
NARRATIVE
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In regards to the allegation "Illegal eviction" it was alleged that the facility staff illegally evicted C1 from the facility. Interviewed Administrator, Assistant Administrator and 3 staff denied the allegation. They stated that C1 was never evicted. Interviews state that C1 was not evicted from the facility. C1 was placed on a 51/50 hold and transported to LACUSC Hospital. File review of incident reports also confirmed that on 06/02/22 C1 was placed on a 51/50 hold and transferred to the LACUSC hospital. No documentation stated that C1 was evicted from the facility. Staff stated that C1 had become aggressive with staff and with clients numerous times and after the incident that occurred on 06/02/22 in which C1 became aggressive with a staff (previous administrator) they called 911 and C1's case worker at Telecare Stepdown so they can come and assess C1 for a hold. After hospitalization C1 didn't return back to the facility and was discharged by Telecare Stepdown on 07/15/22. Interviewed clients stated that they are not aware that any client was evicted from the facility.

In regards to the allegation "Staff does not ensure facility is kept clean and sanitary" it was alleged that the floors were always dirty. Interviewed Administrator, Assistant Administrator and 3 staff denied the allegation. All interviewed clients stated that Facility is clean, and staff is doing very good job. Administrator and Assistant Administrator stated that Maintenance Team, Custodian Team, and Housekeeper Team works together to make sure the facility is clean and sanitary. Facility floors cleaned / mop every day. In the event there is any issues, staff work together to clean the area immediately. Interviewed staff stated that facility is cleaned several times a day by cleaning staff. Sometimes the floors get dirty / sticky down the hallways after coffee is served. That is because the clients will spill it as they walk around. Staff will always mop the hallways daily, also walked throughout the day making sure facility is kept clean and sanitary. Clients interviewed confirmed to see staff cleaning, moping the hallways daily. LPA observed staff cleaning rooms and the hallways during the visit.

Based on interviews, observations, and file review; 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.

An exit interview was conducted, and a copy of this report was provided to Julia Elias, Administrator.

NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Nune Margaryan
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/01/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2