198600539-1-21-2025-28-AS-DSIS-DDK2VS-20250203164422

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198600539
Report Date: 01/21/2025
Date Signed: 01/21/2025 03:51:56 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
01/13/2025 and conducted by Evaluator Erik Zaragoza

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20250113130645

FACILITY NAME:	PICO RIVERA GARDENS		FACILITY NUMBER:	198600539
ADMINISTRATOR:	JOYCE GARCIA		FACILITY TYPE:	735
ADDRESS:	6525 ROSEMEAD BLVD.		TELEPHONE:	(562) 949-8489
CITY:	PICO RIVERA	STATE: CA	ZIP CODE:	90660
CAPACITY:	185	CENSUS: 150	DATE:	01/21/2025
		UNANNOUNCED	TIME BEGAN:	09:26 AM
MET WITH:	Julia Elias - Med Tech Supervisor		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Resident was unlawfully evicted

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Erik Zaragoza conducted an initial unannounced complaint visit to investigate the allegation listed above. LPA met with Julia Elias, Med Tech Supervisor for the facility, and explained the purpose of the visit. Administrator Joyce Garcia arrived shortly thereafter.

The investigation consisted of the following: LPA interviewed Staff #1 - 4 (S1 - S4), obtained copies of the staff and client rosters, and also obtained copies of the house rules, a voluntary discharge form for Client, #1 (C1), reviewed multiple Serious Incident Reports (SIRs) and daily communication log notes involving C1, C1's Physicians Report, appriasal, and FACE Sheet, and also conducted a tour of C1's room. LPA attempted to interview C1 however they are no longer a client at the facility and the client.

The investigation revealed the following: In regards to the allegation that a "Resident was unlawfully evicted," it is alleged that C1 was evicted from the facility without ever receiving any paperwork or any advance notice about their eviction from the facility.

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Erik Zaragoza
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 01/21/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/21/2025

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20250113130645

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: 01/21/2025

NARRATIVE

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During interviews with the staff, four (4) out of four (4) denied the allegation. One of the staff members interviewed stated that C1 voluntarily left the facility and told staff that they would rather live in the streets than have to abide by the facility's house rules and be under supervision by the facility staff, and ultimately signed a voluntary discharge form. The staff furthermore explained that the client has broken multiple facility house rules while living at the facility. Another staff member interviewed explained that C1 was irate on the day they left the facility, assaulted one of the staff of the facility, and ultimately requested to leave the facility which is when they signed the voluntary discharge form. The voluntary discharge form indicates the client decided to voluntarily discharge themselves from the facility effective 1/8/2025. Review of the SIRs and daily communication logs revealed that C1 violated multiple facility house rules including property destruction, substance abuse, threatening staff, assaulting staff, and inviting trespassers into 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 allegations are 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: 01/21/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/21/2025

LIC9099 (FAS) - (06/04)

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