198600539-1-21-2025-28-AS-RORN-DD7S3M-20250123123123

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198600539
Report Date: 01/21/2025
Date Signed: 01/21/2025 03:51:17 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
01/17/2025 and conducted by Evaluator Erik Zaragoza

COMPLAINT CONTROL NUMBER: 28-AS-20250117140433

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:	09:12 AM
MET WITH:	Julia Elias - Med Tech Supervisor		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Staff did not prevent resident from having an altercation with another resident

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), interviewed Clients #1 - 15 (C1 - C15), obtained copies of the staff and client rosters, and also reviewed surveillance video footage of the day the incident took place on 1/17/2025 at approximately 12:45 PM.

The investigation revealed the following: According to the allegation that "Staff did not prevent resident from having an altercation with another resident," it is alleged that R1 and R2 got into an altercation which led to R2 taking off R1's hat and throwing it to the ground, and staff did not intervene to prevent this from happening.

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-20250117140433

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 clients, fourteen (14) out of fifteen (15) interviewed did not corroborate the allegation. One of the clients interviewed stated that they have never witnessed any other of the other clients threatening others in the past. Another client interviewed stated that. Another client interviewed stated that they have witnessed clients threatening other in the facility in the past, however staff did their best to intervene and de-escalate the situation. During interviews with the staff, four (4) out of four (4) denied the allegation. One of the staff members stated that R1 and R2 had gotten into a verbal altercation near the front entrance of the hallways and that R2 did quickly flip off R1's hat during the interaction, however they intervened in the situation right away and prevented further escalation. Another staff member stated that they were not present at the time of the incident. LPA reviewed the video tape of this incident which occurred near the front entrance of the facility on 1/17/2025 at around 12:45 PM and observed that R1 and R2 were arguing and R2 did flip off R1's baseball cap from the front bill very quickly during the exchange, however staff immediately intervened and prevented the situation from further escalating.

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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