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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198600539
Report Date: 06/16/2025
Date Signed: 06/16/2025 01:47:05 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
04/09/2025 and conducted by Evaluator Nicol Wesley
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20250409124404
FACILITY NAME:PICO RIVERA GARDENSFACILITY NUMBER:
198600539
ADMINISTRATOR:JOYCE GARCIAFACILITY TYPE:
735
ADDRESS:6525 ROSEMEAD BLVD.TELEPHONE:
(562) 949-8489
CITY:PICO RIVERASTATE: CAZIP CODE:
90660
CAPACITY:185CENSUS: 171DATE:
06/16/2025
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Joy GarciaTIME COMPLETED:
02:30 PM
ALLEGATION(S):
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Staff does not provide adequate food service to resident.
INVESTIGATION FINDINGS:
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***This LIC 9099/LIC 9099C LIC 9099D Supercedes the LIC 9099/LIC 9099C LIC 9099D that was issued on 04/17/2025.
Licensing Program Analysts (LPA's) Nicol Wesley conducted an unannounced 10 day complaint investigation visit for the allegations listed above. LPA Wesley met with Med Tech Supervisor Julia Elias and Administrator Joyce Garcia and explained the purpose for todays visit. During the visit Andrew DeVera arrived and joined the visit.
Investigation consisted of: requested a copy of the staff and resident roster, interviewed the Med Tech supervisor, Administrator, interviewed staff, and interviewed 12 residents, and requested specific copies of documents.
Regarding allegation: Staff does not provide adequate food service to resident. LPA's Wesley and Madyun interviewed 11 residents and they said, they enjoy the Food and dont have a problem with the food, they have alternative options if they dont like the food that is being served and they can get an alternative choice. None of the residents said that they were denied milk or juice. LPA's interviewed resident #1 who said
Substantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Nicol Wesley
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2025
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 5
Control Number 28-AS-20250409124404
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: 06/16/2025
NARRATIVE
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that he asked staff #1 if he could have some milk and she said no. Resident #1 said he looked at a whole gallon of milk sitting on the back table, but he didn't receive any milk. LPA's visited the kitchen/dining room and interviewed staff #1 who admitted to not giving the resident milk when he asked for it, There were other drink options available.. The Administrator came to the location were the LPA's were sitting and stated that she told the staff they are wasting milk when they pour it into individual cups, because all of the residents don't want milk. So, she said for the kitchen staff to put the milk on the counter and give it to the residents when they request it. .
Based on LPA’s observations and interviews which were conducted, the preponderance of evidence standard has been met, therefore the above allegation is found to be Substantiated. California Code of Regulations are being cited on the attached LIC 9099D.

Appeal rights given.

Exit interview conducted.
NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Nicol Wesley
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 28-AS-20250409124404
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: 06/16/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/25/2025
Section Cited
CCR
80072(a)(3)
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Personal Rights. To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse, or other actions of a punitive nature, including but not limited to: interference with the daily living functions, including eating, sleeping, or...
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The Administrator will conduct and inservice training for staff on Personal rights. Send the sign in sheet with the subject, date and signatures to LPA NIcol Wesley 323 980 4912 by POC date 04/25/25.
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The requirement was not met as evidence by: LPA's & resident #1 went to the kitchen to ask staff #1 about the milk not being given, Staff #1 admitted to not giving resident #1 milk when he asked.
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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: Nicol Wesley
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/16/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 5
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
04/09/2025 and conducted by Evaluator Nicol Wesley
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20250409124404

FACILITY NAME:PICO RIVERA GARDENSFACILITY NUMBER:
198600539
ADMINISTRATOR:JOYCE GARCIAFACILITY TYPE:
735
ADDRESS:6525 ROSEMEAD BLVD.TELEPHONE:
(562) 949-8489
CITY:PICO RIVERASTATE: CAZIP CODE:
90660
CAPACITY:185CENSUS: 173DATE:
06/16/2025
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Joy GarciaTIME COMPLETED:
02:30 PM
ALLEGATION(S):
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Staff is mishandling resident's medication.
INVESTIGATION FINDINGS:
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*****This LIC 9099A/LIC 9099C supersedes the LIC 9099A that was issued on 04/17/2025*****

Licensing Program Analysts (LPA's) Nicol Wesley and Sakinah Madyun conducted an unannounced 10 day complaint investigation visit for the allegations listed above. LPA Wesley met with Med Tech Supervisor Julia Elias and Administrator Joyce Garcia and explained the purpose for todays visit. During the visit Andrew DeVera arrived and joined the visit.

Investigation consisted of: requested a copy of the staff and resident roster, interviewed the Med Tech supervisor, Administrator, interviewed staff, and interviewed 12 residents, and requested specific copies of documents.
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Nicol Wesley
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 28-AS-20250409124404
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: 06/16/2025
NARRATIVE
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LPA's interviewed 11 residents who all stated that they receive their medication on time, and its never compromised, has slime(a nasty looking substance that looks like spit) on it, or the staff never make mistakes when giving their medication to them. Resident #1 said they they have slime on the medication and Staff #2 gave him medication with slime on it, and said, here is your slim pills. LPA's interviewed Staff #2 who said they haven't given any client medication with slime(a nasty looking substance that looks like spit) or any content on it, and never said to resident #1, here's you slime pills.


Based on interviews conducted, and information that was gathered, there is insufficient evidence to support the allegation. Although the allegation(s) may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is UNSUBSTANTIATED.


Exit Interview conducted.
NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Nicol Wesley
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5