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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198600539
Report Date: 10/13/2021
Date Signed: 10/13/2021 03:41:02 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
10/04/2021 and conducted by Evaluator Christine Wong
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20211004094805
FACILITY NAME:PICO RIVERA GARDENSFACILITY NUMBER:
198600539
ADMINISTRATOR:MEIR SHAUL YITZI TEICHMANFACILITY TYPE:
735
ADDRESS:6525 ROSEMEAD BLVD.TELEPHONE:
(562) 949-8489
CITY:PICO RIVERASTATE: CAZIP CODE:
90660
CAPACITY:185CENSUS: 170DATE:
10/13/2021
UNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Julia Elias TIME COMPLETED:
04:00 PM
ALLEGATION(S):
1
2
3
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5
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7
8
9
Staff is inappropriately touching resident
Staff is recording resident
Staff is threatening resident
INVESTIGATION FINDINGS:
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2
3
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5
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7
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9
10
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12
13
Licensing Program Analyst (LPA) Christine Wong conducted an unannounced complaint visit to address the above allegations. LPA met with Medication Supervisor, Julia Elias and Business Office Manger, Aura Co and explained the reason for the visit and they also both assisted LPA with the visit.

The investigation consisted of the following: On today's visit, LPA interviewed seventeen (17) clients (C1-C17), administrator on the phone, seven staff (S1-S7).

The investigation revelead of the following: Allegation#1 "Staff is inappropriately touching resident." LPA interviewed seventeen (17) clients and fifteen (15) clients denied the allegation and reported they never seen any staff did that or they never heard any staff did that. LPA interviewed staff and all denied the allegation. They all reported it never happened and especially during the COVID-19, everyone has to be 6 feet apart.
(See LIC 9099C for continuation)
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Christine Yee
NAME OF LICENSING PROGRAM ANALYST: Christine Wong
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)
Page: 1 of 2
Control Number 28-AS-20211004094805
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#2: "Staff is recording resident." LPA interviewed seventeen (17) clients and sixteen (16) clients denied the allegation and reported they never heard about it and never be aware of it. LPA also interviewed staff and all denied the allegation and reported it never happened. Staff reported one of the client likes to carry the camera around his neck and record the staff but staff never done that to clients.

In regards to the allegation#3: "Staff is threatening resident." LPA interviewed seventeen (17) clients and sixteen (16) clients denied the allegation. Client reported most of the staff treat them well and nice. Only one or two staff would be rude on them but they would never been threatened, cursed or bullied on them. LPA interviewed staff and reported they would never done that to clients and no clients ever complained or reported about any staff threatened them.

Based on statements and interviews conducted with staff and clients as well as LPA observation, 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 and appeal right was provided.
NAME OF LICENSING PROGRAM MANAGER: Christine Yee
NAME OF LICENSING PROGRAM ANALYST: Christine Wong
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)
Page: 2 of 2