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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198600539
Report Date: 03/18/2025
Date Signed: 03/18/2025 09:49:15 AM

Document Has Been Signed on 03/18/2025 09:49 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		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 GARDENSFACILITY NUMBER:
198600539
ADMINISTRATOR/
DIRECTOR:		JOYCE GARCIAFACILITY TYPE:
735
ADDRESS:6525 ROSEMEAD BLVD.TELEPHONE:
(562) 949-8489
CITY:PICO RIVERASTATE: CAZIP CODE:
90660
CAPACITY: 185CENSUS: 155DATE:
03/18/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:46 AM
MET WITH:Julia Elias - Med Tech SupervisorTIME VISIT/
INSPECTION COMPLETED:
10:02 AM
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Licensing Program Analyst (LPA) Erik Zaragoza conducted an unannounced case management visit in response to a death report received on 3/12/2025 for Client #1 (C1). LPA met with Julia Elias, Med Tech Supervisor for the facility, and explained the purpose of the visit. Administrator Joyce Garcia arrived shortly thereafter.

Per the Special Incident Report (SIR), C1 was found unresponsive in their bedroom after they did not come down for their morning medications. Staff went to C1's room to conduct a wellness check and afterwards called paramedics, who pronounced her dead at the scene. Joyce stated that they reviewed the surveillance footage and found that C1 went back to their room at around 9 PM on 3/11/2025, and there was no activity in or out of her room between that time and when she was found in the morning of 3/12/2025.

During today's visit LPA toured the facility and also the bedroom of C1. No health or safety concerns were noted during the visit.

Prior to today's visit, Staff #1 (S1) emailed LPA C1's Physician's Report, FACE Sheet, and Appraisal/Needs and Services Plan. During today's visit, LPA obtained copies of the Medication Administration Records (MARs) for the past three (3) months of C1. Staff explained that they will email LPA a copy C1's death certificate once it becomes available.

No deficiencies were observed during today's visit. Exit interview was held and a copy of the report was provided.
SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Erik Zaragoza
LICENSING EVALUATOR SIGNATURE: DATE: 03/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/18/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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