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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198600539
Report Date: 07/03/2025
Date Signed: 07/03/2025 03:51:32 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 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
07/02/2025 and conducted by Evaluator Blanca Gonzalez
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20250702085553
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:
07/03/2025
UNANNOUNCEDTIME BEGAN:
09:13 AM
MET WITH:Andrew De Vera, Assistant AdministratorTIME COMPLETED:
04:15 PM
ALLEGATION(S):
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Staff did not ensure facility was free of pests
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Blanca Gonzalez and Licensing Program Manager (LPM) Adeline Ho conducted an initial unannounced complaint visit to investigate the allegation listed above. LPA and LPM met with Andrew De Vera, Assistant Administrator and explained the purpose of the visit. Kenyada Melton, maintenance staff assisted with the facility tour.

The investigation consisted of the following: LPA and LPM obtained copies of the staff and client rosters,and maintenance logs, toured six bedrooms, hallways and common area. LPA and LPM interviewed Staff #1 - 6 (S1– S6) and interviewed Clients #1 - 6 (C1 – C6).

In regard to the allegation "Staff did not ensure facility is free of pests", it is alleged that there are a lot of big spiders in their room.

Report continues on LIC 9099C
Substantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Blanca Gonzalez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/03/2025
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 3
Control Number 28-AS-20250702085553
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: PICO RIVERA GARDENS
FACILITY NUMBER: 198600539
VISIT DATE: 07/03/2025
NARRATIVE
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The investigation revealed (3) of (6) clients interviewed stated that there had been spiders and other insects in their rooms and corroborate the allegation. LPA and LPM observed in room #46 possible insects the size of a nickel, and dead bugs inside a light fixture. LPA and LPM observed a dead spider outside of room #14 in the hallway ceiling, a couple of live spiders outside of room #11 in the hallway ceiling and possible bugs in multiple lighting panel covers in the hallways. Cobwebs were observed in the front lobby above the entrance, multiple hallways and rooms #16, #101 and reported roaches in room #43.

Based on LPA and LPM’s interviews and observations the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. Deficiency cited on the attached LIC 9099D.

An exit interview was conducted, and a copy of this report was provided to Andrew De Vera Assistant Administrator. Appeal rights also provided and discussed.
NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Blanca Gonzalez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/03/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 28-AS-20250702085553
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 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: 07/03/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/04/2025
Section Cited
CCR
80087(a)(1)
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80087 Buildings and Grounds
a) The facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors.(1) The licensee shall take measures to keep the facility free of flies and other insects.
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Licencee will submit pictures of areas that were cleaned.
Licensee will meet with maintence and housekeeping and submit a copy of agenda and log of attendees.
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LPA observed live spider outside room #11, dead spider outside room #14, dead bugs in light fixture in room #46 and cobwebs throughout the facility.
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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: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Blanca Gonzalez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/03/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/03/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3