198600539-8-26-2021-28-AS-FFIS-C768NZ-20210923224047

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198600539
Report Date: 08/26/2021
Date Signed: 08/26/2021 03:07:52 PM

Unsubstantiated

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
08/17/2021 and conducted by Evaluator David Sicairos

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20210817090904

FACILITY NAME:	PICO RIVERA GARDENS		FACILITY NUMBER:	198600539
ADMINISTRATOR:	MEIR SHAUL YITZI TEICHMAN		FACILITY TYPE:	735
ADDRESS:	6525 ROSEMEAD BLVD.		TELEPHONE:	(562) 949-8489
CITY:	PICO RIVERA	STATE: CA	ZIP CODE:	90660
CAPACITY:	185	CENSUS: 170	DATE:	08/26/2021
		UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Yitzi Teichman; Administrator		TIME COMPLETED:	03:22 PM

ALLEGATION(S):

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Facility is malodorous.

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPAs) David Sicairos and Luis Mora conducted an unannounced complaint visit regarding the above allegation. LPAs met with Administrator Yitzi Teichman and explained the reason for the visit.

The investigation consisted of the following: LPAs obtained copies of Staff & Client Rosters. LPAs also toured the facility which included but not limited to the common areas and both elevators. LPAs also interviewed Client #1 - Client #11 and Staff #1 - Staff #5.

The investigation revealed the following: in regards to the allegation "facility is malodorous", it is alleged that on 08/10/21, there was a "strong chemical smell" on the elevator of the facility. The odor allegedly smelled like some type of drug and this was not the first occurence, however this could not be confirmed. During today's visit, LPAs toured both facility elevators and did not smell any bad or suspicious odors. LPAs observed staff cleaning the facility during the tour. Per interviews with clients, 10 out of 11 clients indicated that they have not smelled any bad or suspicious odors in the elevator or anywhere else in the facility. (CONTINUED ON 9099C)

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: Rebecca Orendain
NAME OF LICENSING PROGRAM ANALYST: David Sicairos
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 08/26/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2021

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20210817090904

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: 08/26/2021

NARRATIVE

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Interviews conducted with staff members revealed that they have not smelled any bad or suspicious odors in the elevator or anywhere else in the facility. Per staff member interviews, high touch surface areas such as the elevator are cleaned daily and/or as needed. Therefore there was insufficient evidence to corroborate with the allegation.

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 allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Exit interview held and a copy of this report was provided.

NAME OF LICENSING PROGRAM MANAGER: Rebecca Orendain
NAME OF LICENSING PROGRAM ANALYST: David Sicairos
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 08/26/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2021

LIC9099 (FAS) - (06/04)

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