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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198600539
Report Date: 11/20/2024
Date Signed: 11/20/2024 04:54:07 PM

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
05/07/2024 and conducted by Evaluator Noemi Galarza
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20240507135858
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: 150DATE:
11/20/2024
UNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Joyce Garcia & Santos DominguezTIME COMPLETED:
05:00 PM
ALLEGATION(S):
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Drug activity on the premises.
Staff did not provide a comfortable temperature for residents.
Staff did not provide a safe and comfortable environment for residents.
Staff did not provide adequate food service.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Galarza met at the Regional Office with Administrator Joyce Garcia and Consultant Santos Dominguez. The purpose of the meeting was to deliver findings on the above allegations.

The investigation consisted of: A physical plant tour of common areas and kitchen was completed. Staff (S1-S10) and residents (R1- R11) were interviewed. During visit dated 5/9/2024, LPAs Galarza and Tyler Reyes observed 2 residents actively using illegal drugs.. On 10/3/24, Administration staff were alerted of a resident using drugs in the room. Drug paraphernalia was confiscated. Pictures were taken. Relevant documents were obtained during the course of the investigation.
Substantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Noemi Galarza
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 11/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2024
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 10
Control Number 28-AS-20240507135858
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: 11/20/2024
NARRATIVE
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Allegation: Drug activity on the premises. It is alleged that "drug addicts" are using and smoking drugs in the rooms, and there have been multiple instances of trespassers entering the facility to use and/or sell drugs. It was reported that suspected drug users threatened a resident because they found out the activity was reported to Administration staff. A total of 11 residents were interviewed, of which eight (8) stated they have seen residents use "crystal meth". A total of 10 staff were interviewed, of which 9 out 10 staff confirmed there are residents that use drugs in the premises with other residents and trespassers. Staff said that there were at least two (2) residents that was selling drugs and were evicted this year. The type of drugs that have been observed and confiscated by staff are; illegal drugs i.e., methamphetamines and cocaine, as well as the legal drug marijuana. Drug paraphernalia like syringes, pipes, bags of drugs, and drug containers have been observed and removed from resident rooms. Administration staff stated that the facility protocol has been to work with residents that are caught with drugs, and if they do not comply they are then given an eviction notice, and/or referred to a psychiatric evaluation that may result in a hold. However, it was stated that most of the drug users refuse evaluations. Staff reported that many of the suspected drug user residents are caught using drugs at least five (5) times a week during evening and night hours.

Staff stated there is zero tolerance for drugs in the premises and residents are only allowed to smoke cigarettes in the outdoors designated smoking area. However, staff interviews revealed that many of the residents are suspected to use illegal drugs i.e. crystal meth outside of the facility premises, but hide the drug paraphernalia in their person. Staff stated they cannot physically pat down the residents. Staff do room and facility checks every 2 hours. Facility protocol is to notify all appropriate parties i.e. probation officers, and mental health providers if a resident is found using drugs in the premises. New Administrator Joyce Garcia's has put in place the following: Residents are given a verbal warning, a corrective action plan, and finally a 30-day eviction in drug use incidents. There are no physician orders for marijuana use on file.


On 5/9/2024, during physical plant inspection, LPAs Galarza and Tyler Reyes observed two (2) residents handling drug paraphernalia in room 14. Two (2) additional residents were observed smoking drugs out of a pipe in the south outdoor patio. The smoke did not smell like marijuana. LPAs took pictures and obtained resident statements confirming illegal drug use in the premises. On 10/3/2024, while LPA was interviewing new Administrator Joyce Garcia a resident alerted her about two (2) residents using illegal drugs in room 103. Administrator and Assistant Administrator went to the room and confiscated drug paraphernalia. LPA took photographs of the confiscated drug paraphernalia. The information and evidence obtained during the investigation sufficiently supports the allegation.
NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Noemi Galarza
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 11/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 10
Control Number 28-AS-20240507135858
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: 11/20/2024
NARRATIVE
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Allegation: Staff did not provide a comfortable temperature for residents. The complaint alleges that staff were not turning on the air conditioning in the month of May 2024 even when it was uncomfortably hot inside the facility. It was also reported that during excessive heat staff leave the medication room door and front door opened in order to ventilate the rooms, and other times the resident rooms get too cold. Three (3) out of 11 residents stated their room temperature has been too hot because their air conditioning did not work for at least 6 months, so staff provided residents a fan. All 10 staff interviewed stated that the facility maintains a comfortable temperature and the air conditioning is adjusted to 72 Degrees Fahrenheit. Staff stated the facility has 18 air conditioning units, and some resident rooms have temperature control boxes that control the temperature of 4 rooms. Therefore, some residents are not able to control their own room temperature. The findings indicate that on June 21, 2024, the facility paid for the circuit breaker to be fixed and the next day the HVAC upstairs was repaired. On June 22, 2024, Administration staff had to buy fans and ice to keep the residents cool while the system was being repaired. Therefore, there is sufficient evidence to prove the allegation.

Allegation: Staff did not provide a safe and comfortable environment for residents. The complaint alleges there have been multiple instances in which trespassers enter the facility to use or sell drugs and residents do not feel safe. A total of 11 residents were interviewed. One (1) out of 11 residents stated they do not feel safe because of trespassers activity at the facility. Ten (10) residents stated they feel safe, but all 11 residents confirmed they have observed trespassers at the facility, especially at night. A total of 10 staff were interviewed. Nine (9) out of 10 staff acknowledged the facility has had issues with persons trespassing into the facility to rest, use drugs, or sell drugs. Staff identified rooms where trespassers have been found. Additionally, a trespasser was observed sleeping in a tent in a stairway, and another trespasser was observed sleeping in the 2nd floor laundry room. Staff stated most trespassers come into the facility in the evening and night. A former resident is known to trespasses into the facility to use drugs illegal drugs with other residents. The facility has video surveillance but as of October 2024, there is no security in the premises. Based on interviews conducted, there is sufficient evidence to corroborate the allegation.
NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Noemi Galarza
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 11/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 10
Control Number 28-AS-20240507135858
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: 11/20/2024
NARRATIVE
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Allegation: Staff did not provide adequate food service. It is alleged that the food remains consistently the same from morning to bedtime. One (1) out of 11 residents stated that the food is not nutritious because the resident requires a diabetic diet and is not served a modified diet. Most of the residents stated they like the food, but said the menu does not have variety and they would like more vegetables. Kitchen staff stated that meals have protein, starch, and vegetables. If they do not like the food they are offered a sandwich or salad. Facility cook stated they do not have in place modified diets i.e., diabetic, renal, or low sodium diets. According to staff interviews, the facility has a contract with a dietician but they do not visit often. Staff interviews also revealed that there are many spills in the dining room during meal times, but staff and resident volunteers try to clean up the area as soon as the meal service is over. The findings indicate there are 5 residents that are diabetic, but are not being served meals per physician order. Therefore, there is sufficient evidence to corroborate the allegation.

Based on record review, interviews conducted, and photograph evidence, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. Deficiencies are being cited according to California Code of Regulations, Title 22. See LIC 9099D.



An exit interview was conducted with facility Consultant Santos Dominguez. A copy of the report and appeal rights were issued.




NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Noemi Galarza
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 11/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 10
Control Number 28-AS-20240507135858
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: 11/20/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/21/2024
Section Cited
CCR
80078(a)
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Responsibility for Providing Care and Supervision. The licensee shall provide care and supervision as necessary to meet the client's needs.

This requirement was not evidenced by:
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Administrator agreed to submit by tomorrow a written plan of correction that addresses drug use in the facility, facility protocols, and mitigation plan.
In addition, submit proof that all staff were trained in facility protocols when encountering suspected resident drug users.
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Based on interviews and photograph evidence the findings indicate that there are residents that use illegal drugs i.e., crystal meth, and legal drug marijuana, which poses an immediate health and safety risk to persons in care.
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Type B
11/27/2024
Section Cited
CCR
80088(a)(1)
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Furniture, Fixtures, Equipment, and Supplies. The licensee shall maintain the temperature in rooms that clients occupy between a minimum of 68 degrees F (20 degrees C) and a maximum of 85 degrees F (30 degrees C).
This requirement was not met evidenced by:
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Administrator agreed to submit proof that the HVAC circuit breaker was repaired.
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Based on record review and interviews conducted, the facility's HVAC circuit breaker upstairs was in disrepair. On June 22, 2024 the HVAC issue was repaired. This posed a potential health and safety risk to persons in care.
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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: Noemi Galarza
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 11/20/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 10
Control Number 28-AS-20240507135858
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: 11/20/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/21/2024
Section Cited
CCR
80072(a)(2)
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Personal Rights. To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs.

This requirement was not met evidenced by:
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Administrator shall submit a written plan of correction addressing facility protocols that addresses a contingency plan for trespassers.

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Based on interviews conducted, the findings indicate that there are known trespassers whom are entering the facility to use and/or sell drugs, or to sleep in the premises. This poses a potential health and safety risk to persons in care.
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Type B
11/27/2024
Section Cited
CCR
80076(6)(A)
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Food Services. Modified diets prescribed by a client's physician as a medical necessity shall be provided. The licensee shall obtain and follow instructions from the physician or dietitian on the preparation of the modified diet. This requirement was not evidenced by:
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Administrator agreed to:
1. Submit a written plan of correction.
2. Contact dietician to obtain a modified diet for 5 residents that require a diabetic diet.
3. Dietician shall train all kitchen staff in dietary needs. Submit proof of training.
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Based on interviews conducted, the findings indicate that the facility has 5 residents that require a diabetic diet, but are being served regular diet, which poses a potential health and safety risk to persons in care.
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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: Noemi Galarza
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 11/20/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2024
LIC9099 (FAS) - (06/04)
Page: 6 of 10
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
05/07/2024 and conducted by Evaluator Noemi Galarza
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20240507135858

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: 150DATE:
11/20/2024
UNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Joyce Garcia & Santos DominguezTIME COMPLETED:
05:00 PM
ALLEGATION(S):
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Staff mismanaged residents’ medication.
Staff yelled at resident.
Staff did not ensure to keep facility free of bedbugs and cockroaches.
Staff threatened residents with eviction.
Facility is unsanitary.
Staff did not ensure to keep medications locked.





Staff did not ensure to keep medications locked.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Galarza met at the Regional Office with Administrator Joyce Garcia and Consultant Santos Dominguez. The purpose of the meeting was to deliver findings on the above allegations.

The investigation consisted of: A physical plant tour of common areas and kitchen was completed. Staff (S1-S10) and residents (R1- R11) were interviewed. During visit dated 5/9/2024, LPAs Galarza and Tyler Reyes observed 2 residents actively using illegal drugs. On 10/3/24, Administration staff were alerted of a resident using drugs in the room. Drug paraphernalia was confiscated. Pictures were taken. Relevant documents were obtained during the course of the investigation.
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Noemi Galarza
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 11/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 7 of 10
Control Number 28-AS-20240507135858
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: 11/20/2024
NARRATIVE
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Allegation: Staff mismanaged residents’ medication. It was reported that two night shift med-tech staff have on multiple occasions mismanaged resident's medications and have administered the "wrong pills" and "seem to put too many meds in the cup". A total of 10 staff were interviewed of which all denied the allegation and/or stated they have no knowledge of medication errors. Staff stated that the facility serves mentally disabled adults that are at times delusional and complaint about the effects of medications that are administered. Per staff interviews, sometimes resident's dosages are adjusted per physician or psychiatrist orders. In instances in which residents do not go to the med-tech room to obtain their medications staff call the residents. Staff said that there are occasions in which residents refuse their medications, and the facility follows reporting requirements. A total of 11 residents were interviewed, of which 9 denied the allegation and two (2) stated they are administered wrong medications. On 5/9/2024, LPA toured the medication room, observed medication dispensing and documentation practices. No concerns were observed. During subsequent visits, LPA observed the medication room locked with a keypad at the door and inaccessible to residents. There is insufficient evidence to corroborate the allegation.

Allegation: Staff yelled at resident. It is alleged that med-tech staff and Assistant Administrator yell at residents by raising their voice at residents when they do not listen to redirection. According to staff interviews conducted, all staff denied the allegation and stated they do not violate resident rights. Staff reported that the only time residents have been told about evictions has been during resident council meetings, in which house rules are discussed. A total of 11 residents were interviewed, of which 10 out of 11 denied the allegation. One resident stated that male Assistant Administrator has "cussed at me". However, the majority of residents stated med-tech staff and Administration staff are nice. Resident interviews revealed that some residents yell at staff and as a result staff raise their voice and firmly address the residents, but without a verbal abuse intent. No inappropriate communication between residents and staff was observed during the visits. There is insufficient evidence to corroborate the allegation.
NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Noemi Galarza
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 11/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2024
LIC9099 (FAS) - (06/04)
Page: 8 of 10
Control Number 28-AS-20240507135858
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: 11/20/2024
NARRATIVE
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Allegation: Staff did not ensure to keep facility free of bedbugs and cockroaches. It is alleged that the facility has an infestation of bedbugs and cockroaches which are not being addressed by staff. A total of 11 residents were interviewed, of which six (6) out of 11 residents stated the facility has bed bugs, cockroaches, and rodents. Nine (9) out of 10 staff confirmed that the facility has an ongoing problem of bed bugs and cockroaches. Staff stated the facility has pest control extermination services contract in place who regularly visit the facility. The rooms identified in need of extermination are treated twice a week. Dewey Pest Control comes to the facility once a week, and the other day the maintenance staff team treats the rooms with the problem. Staff and residents acknowledged the issue but stated the facility has always addressed the ongoing issue. This allegation has been investigated in recent months. Based on record review and interviews conducted there is insufficient evidence to corroborate the allegation.

Allegation: Staff threatened residents with eviction. It is alleged that Assistant Administrator becomes upset when residents complain about medication errors and threatens to report residents to Administrator for an eviction. All 10 staff interviewed denied the allegation. Assistant Administrator stated that they do not threaten any residents with an eviction when resident report medication errors or when they are reminded of facility rules. A total of 11 residents were interviewed, of which 2 out of 11 residents reported that when staff gets angry they threaten residents with an eviction. There is insufficient evidence to corroborate the allegation.

Allegation: Facility is unsanitary. It is alleged the facility is cleaned regularly but trash is observed in the premises, plates are not being cleaned properly, and the kitchen and dining room area often has flies. All staff denied the allegation. They reported that daily housekeeping is performed in all common areas, hallways, kitchen area, and resident rooms. Staff stated that the facility is "relatively" clean, but that residents drop food and make a lot of spills everywhere. Only (1) out of 11 residents reported issues with facility cleanliness. Most of the residents stated the facility is regularly cleaned. Both staff and residents said that throughout the day some residents spill food and drinks as they walk through the facility. During all visits, LPA observed housekeeping, kitchen staff, and maintenance staff performing routine routine housekeeping and corrective maintenance in the upkeep of the facility. There is insufficient evidence to corroborate the allegation.

NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Noemi Galarza
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 11/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2024
LIC9099 (FAS) - (06/04)
Page: 9 of 10
Control Number 28-AS-20240507135858
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: 11/20/2024
NARRATIVE
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Allegation: Staff did not ensure to keep medications locked. It is alleged that a resident on an unknown date attempted to enter the medication room at 3:00 AM because a noc-shift med-tech staff left the med-tech room door opened. According to resident interviews conducted all 11 residents denied the allegation and stated the med-tech room door is always locked. All 10 staff interviewed also denied the allegation. Staff stated the medication room has a dutch door with a key pad that is always kept locked. The facility always has two (2) night shift staff that work in the med-room. Facility protocol is that med-techs cannot leave the room unlocked if they step away. The PM shift has 2 med-techs and morning shift has 3 med-techs. None of the staff and residents interviewed stated they have observed the medication room unlocked. The allegation could not be supported.

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 are Unsubstantiated.

An exit interview was conducted with facility Consultant Santos Dominguez. A copy of the report and appeal rights were issued.
NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Noemi Galarza
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 11/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2024
LIC9099 (FAS) - (06/04)
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