198600539-8-8-2025-28-AS-DSIS-DLNSTT-20250919141001

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198600539
Report Date: 08/08/2025
Date Signed: 08/08/2025 02:10:00 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
08/01/2025 and conducted by Evaluator Erik Zaragoza

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20250801084618

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: 167	DATE:	08/08/2025
		UNANNOUNCED	TIME BEGAN:	09:28 AM
MET WITH:	Julia Elias - Med Tech Supervisor		TIME COMPLETED:	02:21 PM

ALLEGATION(S):

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Staff interacts with resident in an inappropriate manner
Staff prevented resident from exiting the elevator
Staff yells at resident

INVESTIGATION FINDINGS:

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

The investigation consisted of the following: LPA conducted a tour of the facility, obtained copies of the staff and client rosters, interviewed Clients #1 - 16 (C1 - C16), and Staff #1 - 4 (S1 - S4).

The investigation revealed the following: In regards to the allegation that "Staff interacts with resident in an inappropriate manner," it is alleged that S3 and S4 were blocking the hallway in which C1 was attempting to pass through, and gave C1 a bad attitude as C1 was attempting to move past them.

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Erik Zaragoza
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 08/08/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2025

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-20250801084618

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: 08/08/2025

NARRATIVE

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During interviews with the clients, fourteen (14) out of sixteen (16) interviewed did not corroborate the allegation. One client stated that they have never witnessed any of the staff members treating clients in a rude or inappropriate manner. Another client interviewed stated that the staff are nice and kind, and all of them treat the clients in a respectful manner. During interviews with the staff, none of them corroborated the allegation. S3 stated that they were doing medication passes in client bedrooms and said "excuse me" to C1 since they were crossing each other, and it appeared to have triggered C1. S4 stated that C1 walked passed them in the hallway and started yelling at them saying that S3 and S4 were blocking them, however this was not the case.

In regards to the allegation that "Staff prevented resident from exiting the elevator," it is alleged that C1 had attempted to exit an elevator at the facility, however S3 was blocking their exit and wouldn't let C1 get out of the elevator. During interviews with the clients, fifteen (15) out of sixteen (16) interviewed did not corroborate the allegation. One client interviewed stated that the staff never bother them when they are using the elevator and trying to exit. Another client stated they have never witnessed anything like staff preventing clients from exiting elevators in the past. During interviews with staff, none of them corroborated the allegation. S2 stated that they have never attempted to block the elevator exit from C1 when they use the elevator at the same time. Other staff have no knowledge of this alleged incident.

NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Erik Zaragoza
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 08/08/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2025

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20250801084618

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: 08/08/2025

NARRATIVE

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In regards to the allegation that "Staff yells at resident," it is alleged that S2 had yelled at C1 because S2 wanted C1 to change their primary doctor to the facility doctor. During interviews with the clients, fifteen (15) out of sixteen (16) did not corroborate the allegation. One of the clients interviewed stated that they have never witnessed the staff members yell at any of the clients in the past. Another client interviewed stated that they have witnessed clients yelling at staff members, however they have never witnessed staff raise their voices at the clients. During interviews with the staff, none of them corroborated the allegation. S2 stated that they never yelled at C1, and stated that they offered C1 to make a primary medical provider change to the doctor that works at the facility, but never raised their voice when speaking to C1. Other staff stated they have never witnessed S2 raise their voice at any of the clients.

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 will be emailed to the administrator.

NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Erik Zaragoza
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 08/08/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2025

LIC9099 (FAS) - (06/04)

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