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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198600539
Report Date: 10/28/2021
Date Signed: 10/28/2021 11:53:24 AM

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
10/19/2021 and conducted by Evaluator Jose Villalobos
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20211019150055
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: 172DATE:
10/28/2021
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Administrator Yitzi Teichman TIME COMPLETED:
12:00 PM
ALLEGATION(S):
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9
Facility staff is not providing adequate food service.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Jose Villalobos conducted an unannounced complaint visit to address the above allegations. LPA met with Administrator Yitzi Teichman and Supervisor Julia Elias. The purpose of the visit was discussed.

The investigation consisted of the following: On today's visit, LPA toured the physical plant and observed the food supply from 9:45-10:30am, interviewed client #1-#12 (C1-C12), and interviewed Staff #1-#6 (S1-S6) between 10:30am-11:15am.

The investigation revealed of the following: In regards to the allegation, "Facility staff is not providing adequate food service." it was alleged that on 10/19/21 kitchen staff reused a plate a resident already ate off of instead of throwing it away. (6) of (6) Staff interviewed denied the allegation. (11) of (12) Clients interviewed could not corroborate the allegation. Interviews with staff show that clients are handed their food one by one. If a client returns their plate for whatever reason, the food is thrown into the trash.

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: 10/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2021
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-20211019150055
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: 10/28/2021
NARRATIVE
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As an infection control measure, the facility served meals on plastic plates that can be disposed of after each use. LPA observed multiple trash can throughout the dining and kitchen area. Interviews with clients show that staff have not been observed reusing anyone's leftover meal to prepare another clients meal. One (1) client interviewed believes staff may be reusing food but had not observed it. 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 may have happened or are 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 was conducted with Yitzi Teichman and Julia Elias. 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: 10/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 2