198600539-10-13-2021-28-AS-MVAO-CDMRL6-20220419130638

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198600539
Report Date: 10/13/2021
Date Signed: 10/13/2021 04:25:48 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
06/15/2021 and conducted by Evaluator Jose Villalobos

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20210615113054

FACILITY NAME:	PICO RIVERA GARDENS		FACILITY NUMBER:	198600539
ADMINISTRATOR:	DOMINGUEZ, SANTOS		FACILITY TYPE:	735
ADDRESS:	6525 ROSEMEAD BLVD.		TELEPHONE:	(562) 949-8489
CITY:	PICO RIVERA	STATE: CA	ZIP CODE:	90660
CAPACITY:	185	CENSUS: 172	DATE:	10/13/2021
		UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Supervisor Julia Elias		TIME COMPLETED:	03:45 PM

ALLEGATION(S):

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Client is selling illegal drugs while in care
Client attacked another client while in care
Staff is providing care and supervision while under the influence
Client is not afforded privacy while in care

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jose Villalobos initiated a subsequent complaint investigation for the allegations listed above. LPA Villalobos met with Supervisor Julia Elias.

LPA Villalobos conducted the initial complaint visit on 6/16/21. Department Investigator, investigated further. The investigation consisted of the following: LPA Villalobos conducted a health and safety check, obtained staff and clients roster, copies of client #1’s (C1) facility file, interviewed Staff #4 (S4), and interviewed clients #5-#8 (C5-C8). Department Investigator conducted the following: obtained C1’s client records, reviewed staff files, contacted local sheriffs department, interviewed staff #1-#3 (S1-S3), and clients #1-#4 (C1-C4).

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: 10/13/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2021

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-20210615113054

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: 10/13/2021

NARRATIVE

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The investigation revealed the following: In regards to the allegation that "Client is selling illegal drugs while in care" it was alleged that C2 was selling methamphetamines inside the facility. (4) of (4) staff interviewed denied the allegation. (8) of (8) clients interviewed could not corroborate the allegation. Interviews from the Departments Investigator concluded that there was no evidence to prove that C2 was selling drugs in the facility. Calls to the sheriffs department concluded that no such reports were made to their department on the matter as well. Interview with investigator shows that C2 also denied using or selling drugs. Based on interviews conducted and observations, there is not enough evidence to support the 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

In regards to the allegation, "Client attacked another client while in care " it was alleged that on 5/19/21 C2 attacked C1 in the facility. (4) of (4) staff interviewed denied the allegation. (7) of (8) clients interviewed could not corroborate the allegation. Interview conducted by the departments investigator concluded that this altercation had no witnesses and no reports were made of the conflict. Staff denied the incident ever happened as it was not reported to them and they did not observe it. Based on interviews conducted and observations, there is not enough evidence to support the 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

In regards to the allegation, "Staff is providing care and supervision while under the influence " it was alleged that S1 works while under the influence in the facility. (4) of (4) staff interviewed denied the allegation. (7) of (8) clients interviewed could not corroborate the allegation. Interviews with clients and staff show that S1 is professional and helpful to clients in care. LPA and Investigator did not observe signs of S1 being under the influence during the visits. Review of S1's file does not show discipline notes for being under the influence. LPA Villalobos and department investigator did not acquire proof that S1 provides care and supervision while under the influence. Based on interviews conducted, observations, and file reviews there is not enough evidence to support the 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

NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Jose Villalobos
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 10/13/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2021

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20210615113054

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: 10/13/2021

NARRATIVE

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In regards to the allegation "Client is not afforded privacy while in care " it was alleged that there is a conspiracy against C1 to mess with C1's life. (4) of (4) staff interviewed denied the allegation. (7) of (8) clients interviewed could not corroborate the allegation. Interviews show that C1 does not trust clients or staff in the facility as C1 believes they are conducting "organized gang stalking and harassment". C1 was not able to provide evidence of gang stalking to LPA or department investigator. Clients interviewed denied stalking or harassing C1. Based on interviews conducted and observations, there is not enough evidence to support the 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 conducted with Supervisor 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: 10/13/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2021

LIC9099 (FAS) - (06/04)

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