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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198600539
Report Date: 08/26/2024
Date Signed: 08/26/2024 09:16:32 AM

Substantiated


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
08/05/2024 and conducted by Evaluator Jewel Baptiste
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20240805142604
FACILITY NAME:PICO RIVERA GARDENSFACILITY NUMBER:
198600539
ADMINISTRATOR:JULIA ELIASFACILITY TYPE:
735
ADDRESS:6525 ROSEMEAD BLVD.TELEPHONE:
(562) 949-8489
CITY:PICO RIVERASTATE: CAZIP CODE:
90660
CAPACITY:185CENSUS: 137DATE:
08/26/2024
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Assistant Administrator Andrew De VeraTIME COMPLETED:
09:30 AM
ALLEGATION(S):
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Staff did not address a bedbug infestation in the facility
Staff did not address an infestation of cockroaches in the facility
INVESTIGATION FINDINGS:
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 “The reason for the visit is to correct the POC dates on the report dated 8/9/24.”

On 8/09/2024 at 8:50 a.m., Licensing Program Analyst (LPA) Jewel Baptiste conducted an unannounced complaint visit regarding the above allegations. LPA met with the Assistant Administrator Tony Olmos and discussed the purpose of the visit. LPA met the Administrator Julia Elias at 11: 05 a.m. and explained the reason for the visit.

During today’s visit, LPA obtained the staff roster, client roster, and pest control invoice. LPA toured the facility with the Maintenance Assistant Rueven Gohnmardi, and inspected room # 2, 9, 16, 37, 42, 47, 48, 52, 56, 60, 104 and 20. LPA took photos of bed bugs and dead roaches. LPA interviewed the Administrator and a total of 3 staff, who shall be referred to as S1 through S3. LPA interviewed a total of 14 clients, who shall be referred to as C1 through C14.

Report continued on 9099c.
Substantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Jewel Baptiste
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2024
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 3
Control Number 28-AS-20240805142604
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: 08/26/2024
NARRATIVE
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The investigation reveals the following: Regarding “Staff did not address a bedbug infestation in the facility”. It was alleged the facility has bed bugs. In the interview the Administrator stated the facility spray for bed bugs and the pest control company come at least once a month. 1 out of 3 staff stated they have not seen bed bugs but heard the facility had it in the past. 2 out of 3 staff confirmed the facility has bed bugs. 10 out of 14 clients stated they do not have bed bugs. 4 out of 10 bedbugs stated they have bed bugs. During the tour LPA took photos of bed bugs in room# 52.

The investigation reveals the following: Regarding “Staff did not address an infestation of cockroaches in the facility”. It was alleged the facility has roaches. The Administrator stated maintenance spray for roaches and is unaware of roaches in the client rooms. 1 out 3 staff stated they have not seen roaches. 2 out of 3 staff stated they have seen little roaches since the fumigation. 5 out of 14 clients stated they do not have roaches in their rooms. 9 out of 14 clients stated they have roaches in their rooms. During the tour LPA took a photo of dead roaches in client’s drawers.

Based on LPA observation, interviews and file review, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. California Code of Regulation, Title 22 are being cited on the attached LIC9099D.



Exit interview conducted with Assistant Administrator Tony Olmas and a copy of this record provided.
NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Jewel Baptiste
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3
Control Number 28-AS-20240805142604
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/26/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/29/2024
Section Cited
CCR
80087(a)(1)
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 Buildings and Grounds. Licensees shall take measures to keep the facility free of flies and other insects.
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Administrator will ensure that a visual inspection is conducted in ALL the clients bedrooms and the infested rooms will be immediately treated. A report of all the rooms treated and A PLAN OF ACTION, which may require retaining a professional pest control company to specifically treat the bedbugs and roaches, will be also be submitted to CCLD documenting
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 LPA observed many live bed bugs in room #52, and interviews confirmed room #60 has bed bugs. LPA also noted dead roaches in room #16, which poses/posed a potential health, safety or personal rights risk to
persons in care.
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how the facility will ensure that all clients rooms and common areas are free from bed bugs and roaches by 08/29/2024.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Jewel Baptiste
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/26/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3