198600539-6-12-2025-28-AS-DSIS-DJGSBY-20250711134443

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198600539
Report Date: 06/12/2025
Date Signed: 06/12/2025 04:41:51 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
05/27/2025 and conducted by Evaluator Erik Zaragoza

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20250527135615

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: 168	DATE:	06/12/2025
		UNANNOUNCED	TIME BEGAN:	09:32 AM
MET WITH:	Julia Elias - Med Tech Supervisor		TIME COMPLETED:	04:30 PM

ALLEGATION(S):

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Staff did not ensure resident's medication is not contaminated
Staff made inappropriate comments towards resident
Staff are not providing adequate food service to resident
Staff did not prevent residents from smoking in their rooms
Staff are not providing a comfortable environment for resident
Staff did not prevent resident from engaging in inappropriate behaviors

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Erik Zaragoza conducted a subsequent unannounced complaint visit to investigate and deliver findings on the allegations listed above. LPA met with Julia Elias, Med Tech Supervisor for the facility, and explained the purpose of the visit. LPA met with administrator Joyce Garcia shortly thereafter.

During the initial visit conducted on 5/29/2025,LPA obtained the staff and resident rosters, conducted a tour of the facility including the kitchen during meal preparation time, interviewed Clients #1 - 17 (C1 - C17), Staff #1 - 7 (S1 - S7), and toured seven (7) resident bedrooms. During today's visit, LPA reviewed the medications for C1 and delivered findings. LPA attempted to interview Staff #8 (S8), however they no longer work at 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: 06/12/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2025

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 4

Control Number 28-AS-20250527135615

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: 06/12/2025

NARRATIVE

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In regards to the allegation that "Staff did not ensure resident's medication is not contaminated," it is alleged that the medications of C1 were contaminated by a white powdery substance and that it also smells of perfume. During interviews with the clients, sixteen (16) out of seventeen (17) interviewed did not corroborate the allegation. One of the clients interviewed stated that there have been no issues with their medications and have never seen their medication contaminated with anything. Another client interviewed stated that none of their medications have had any unusual foreign substances in them. During interviews with the staff, none of them corroborated the allegation. One of the staff interviewed stated that they ensure to pop C1's medications directly into the cup and also put a lid on top of it as well to ensure that there is nothing contaminating their medications. Another staff members similarly stated that they place lids on the medication cup of C1 after dispensing the medications into their cup to make sure they are not contaminated with any substance. During review of C1's medications, LPA did not observe any powdery substance in C1's medications.

In regards to the allegation that "Staff made inappropriate comments towards resident," it is alleged that S7 told C1 "here come your slime pills" when distributing medications to C1. During interviews with the clients, thirteen (13) out of seventeen (17) interviewed did not corroborate the allegation. One of the staff interviewed stated that the staff have never used inappropriate language towards them or any other clients in the facility. Another client interviewed stated that they have never heard staff make inappropriate comments in the facility, During interviews with the staff, none of them corroborated the allegation. S7 stated that they have never said anything like what was alleged in the allegation. Another staff interviewed stated that they have never heard of other staff members making inappropriate comments towards clients.

In regards to the allegation that "Staff are not providing adequate food service to resident," it is alleged that C1 had found a hair in their nachos, and when asking for another plate they were told that they cannot have a second serving. During interviews with the clients, fourteen (14) out of seventeen (17) interviewed did not corroborate the allegation. One of the clients interviewed stated that they had no issues with the food served at the facility. Another client interviewed stated that they have never seen any contaminants in the food served at the facility and had no problems with it. One of the staff members interviewed stated that the food is not contaminated, and that the food at the facility is not contaminated and that clients are offered seconds, however only after everyone in the facility has been served a plate. S8 was not able to be interviewed regarding the incident due to no longer working at the facility. During a tour of the kitchen during meal prep at lunchtime, LPA did not observe the food to be contaminated with any substances.

NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Erik Zaragoza
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 06/12/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 28-AS-20250527135615

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: 06/12/2025

NARRATIVE

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In regards to the allegation that "Staff did not prevent residents from smoking in their rooms," it is alleged that clients in the row of 40s rooms are smoking marijuana and that the odor is present in the hallway. During interviews with the clients, sixteen (16) out of seventeen (17) did not corroborate the allegation. One of the clients who lives in the 40s hallways stated that they have never noticed the odor of marijuana in the hallways outside their room. Another client interviewed stated that they also have not noticed the odor of marijuana nywhere in the facility. During interviews with the staff, none of the corroborated the allegation. One of the staff interviewed stated that marijuana smoking is not allowed in the facility, and they have not received any reports of marijuana smoking in the 40s rooms hallways. Another staff member interviewed stated that they have not found evidence of any clients smoking marijuana in the facility. During the physical plant tour LPA toured seven (7) rooms in the 40s units and did not notice the odor or presence of marijuana in any of the rooms or in the hallways.

In regards to the allegation that "Staff are not providing a comfortable environment for resident," it is alleged that S5 was yelling at clients through the intercom system that was placed at an uncomfortably loud volume. During interviews with the clients, fourteen (14) out of seventeen (17) did not corroborate the allegation. One client interviewed stated that they have never heard any of the staff yelling or screaming through the intercom system and that it is at an appropriate volume. Another client interviewed stated that there have been no issues with staff yelling at clients through the intercom. During interviews with staff, none of them corroborated the allegation. S5 stated that they have never yelled through the intercom system to clients. Another staff member stated that this is not happening and that staff are not yelling into the intercom system. During the physical plant tour of the facility, LPA did not overhear any of the staff yelling at clients through the intercom.

NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Erik Zaragoza
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 06/12/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2025

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 28-AS-20250527135615

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: 06/12/2025

NARRATIVE

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In regards to the allegation that "Staff did not prevent resident from engaging in inappropriate behaviors," it is alleged that there are clients at night who have been banging on doors and hallways at night, cursing and screaming at that staff are not preventing this from occurring. During interviews with the clients, twelve (12) out of seventeen (17) interviewed did not corroborate the allegation. One client interviewed stated that they have noticed clients doing this at night in the past, however the staff did take action by evicting the client. Another client interviewed stated they have not noticed banging or screaming in the hallways at night. During interviews with the staff, none of them corroborated the allegation. One staff interviewed stated that they have not received any reports of clients banging on the walls or screaming in the hallways at night from any staff. Another staff member stated that whenever they receive reports of clients banging on the doors and screaming at night they do intervene and tell them to stop.

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: 06/12/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2025

LIC9099 (FAS) - (06/04)

Page: 4 of 4