198600539-9-16-2021-28-AS-FFIS-CDQP8Y-20220422110618

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198600539
Report Date: 09/16/2021
Date Signed: 09/16/2021 03:30:30 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
09/07/2021 and conducted by Evaluator Jose Villalobos

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20210907102549

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: 172	DATE:	09/16/2021
		UNANNOUNCED	TIME BEGAN:	12:45 PM
MET WITH:	Supervisor Julia Elias		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Facility not provided adequate food service.
Facility is not providing a sanitized environment for residents.
Staff allow residents to smoke inside the facility.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jose Villalobos conducted an unannounced complaint visit regarding the above allegations. LPA met with Supervisor Julia Elias and explained the reason for the visit.

The investigation consisted of the following: LPA obtained copies of Staff & Client Rosters. LPA also toured the facility and observed the food supply between 1pm-2pm. LPA also interviewed Clients #1 - Client #8 (C1-C8) and Staff #1 - Staff #5 (S1-S5)

The investigation revealed the following: in regards to the allegation "Facility not provided adequate food service", it was alleged that the facility served C1 breakfast on 9/7/21 that was unsanitary. (5) of (5) staff interviewed denied the allegation. (7) of (8) clients interviewed could not corroborate the allegation. C1 stated that there appeared to be an eyelash and plastic on their food plate that morning. C1 did not inform staff and stated they finished their food. LPA was not provided with photo evidence to confirm....

Continued on LIC 9099-C

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Jose Villalobos
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 09/16/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2021

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-20210907102549

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: 09/16/2021

NARRATIVE

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LPA observed kitchen staff serving lunch from 1pm-1:45pm and did not observe any clients complain about the food service. LPA observed Kitchen staff wearing proper protective equipment when serving the meals to the clients. Based on interviews conducted and LPA observations there was insufficient evidence to corroborate with the allegation.

In regards to the allegation, "Facility is not providing a sanitized environment for residents." it was alleged that facility staff don't clean the food area. (5) of (5) staff denied the allegation. (7) of (8) clients interviewed could not corroborate the allegation. Interviews with staff show that the food area is cleaned before and after each meal time. LPA observed between 1pm-1:45pm that staff continuously walk the food area picking up after any mess left by clients in care before other clients sit to eat their meals. LPA observed staff go into the food area at 1:50pm and begin mopping any spills left over. Based on interviews conducted and LPA observations there was insufficient evidence to corroborate with the allegation.

In regards to the allegation , "Staff allow residents to smoke inside the facility." it was alleged that residents smoke inside the facility on the second floor and in the laundry rooms. (5) of (5) staff interviewed denied the allegation. (7) of (8) clients interviewed could not corroborate the allegation. LPA was not provided with information as to who was smoking inside the facility and specific details on when it occurs. Interviews with clients and staff show that everyone is aware of the house rule to not smoke inside of the facility but instead smoke in the designated areas located on the outside of the building. LPA obtained a copy of the facility house rules. Based on interviews conducted, observations and review of documents there was insufficient evidence to corroborate with the allegation.

Based on statements and interviews conducted with staff and clients as well as LPA observations and facility documents reviewed, there was not enough supportive evidence to concur with the reported allegations. Although the allegation(s) may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation(s) are UNSUBSTANTIATED.

Exit interview was conducted with Julia Elias and a copy of this report was provided.

NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Jose Villalobos
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 09/16/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2021

LIC9099 (FAS) - (06/04)

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