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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198600539
Report Date: 07/11/2024
Date Signed: 07/11/2024 03:27:58 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
07/03/2024 and conducted by Evaluator Nune Margaryan
COMPLAINT CONTROL NUMBER: 28-AS-20240703140606
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: 133DATE:
07/11/2024
UNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Tony Olmos, AdministratorTIME COMPLETED:
03:30 PM
ALLEGATION(S):
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9
Staff interacted with client in an inappropriate manner.
INVESTIGATION FINDINGS:
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13
Licensing Program Analyst (LPA) Nune Margaryan made an unannounced complaint visit regarding the allegation above and met with Administrator Tony Olmos . The purpose of the visit was discussed.

The investigation consisted of the following: LPA Margaryan obtained a copy of the staff roster, client roster, SIRs dated 07/01/24 and 07/09/24, daily communication log sheet for 07/01/24, S1's, S5's and C1's declaration forms / statements regarding the incident and Staff inservice log in sheet ( Subject: Documentation / Comunication) . LPA interviewed the Administrator, Staff 1 - Staff 4 (S1 - S4) and Client 1 - Client 13 (C1 - C13). LPA attempted to interview Staff 5 (S5) over the phone but was unable to reach after several attempts.

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: 07/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2024
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-20240703140606
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: 07/11/2024
NARRATIVE
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Regarding allegation: Staff interacted with client in an inappropriate manner. It was alleged that S1 is having an inappropriate relationship with C1, and most recent incident (that RP aware of) between S1 and C1 occurred on 7/1/24. C1 was laying down on the bed and S1 was standing over him and was caressing C1's face.

During today’s investigation, interviewed Administrator and staff indicated they have not observed any staff interact with clients in an inappropriate manner (including C1). Interviewed staff indicated they are trained how to interact with clients. interviewed S1 denied ever standing over C1 and caressing C1's face. All staff interviewed also denied ever observing S1 caressing C1's or other clients face. Interviewed Administrator stated that he was aware of the incident and conducted investigation about this matter. Administrator stated during the investigation from 07/01/24 S1 was suspended and returned to work on 07/08/24 after investigation completed. During the investigation it turned out that the staff (S5) misinterpreted / misunderstood what he/she had seen. Interviewed clients denied the allegation. They stated that didn't observe that any staff interact with clients (including C1) in an inappropriate manner. Staff and Client interviews were unable to corroborate this allegation.


Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated.

Exit interview held and a copy of the report was provided.
NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Nune Margaryan
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2