198600539-11-17-2021-28-AS-MVAO-CBGVRC-20220209153944

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198600539
Report Date: 11/17/2021
Date Signed: 11/17/2021 04:29:22 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
09/17/2021 and conducted by Evaluator Glenn Trueman

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20210917163242

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: 168	DATE:	11/17/2021
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Yitzi Teichman		TIME COMPLETED:	12:15 PM

ALLEGATION(S):

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Staff and residents had inappropriate interactions.
Staff made inappropriate comments to resident.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Glenn Trueman conducted a subsequent visit to investigate the above allegations and was met by Administrator Yitzi Teichman.
At today's visit 11/17/21 from 9:30 A.M. to 11:30 A.M. Client's 2-6 were interviewed and Staff #1 and # 2 were interviewed.
Initial visit was conducted on 9/22/21 and LPA Trueman interviewed Administrator Yitzi Teichman and Assistant Administrator Julia Elias from 2:00 PM to 2:50 P.M.. Resident and Staff Roster was submitted.
Various documents were submitted from Client (C1) 1's file.
In regards to the allegation Staff and residents had inappropriate interactions, based on interviews conducted and information gathered it was revealed that the roster for 2019 and 2020 did not have a Staff Benjamin.
All clients interviewed had not known of a staff Benjamin. All clients interviewed had not observed any inappropriate interaction with staff and client's. Client's interviewed stated that staff have been very respectful. Interview with Client 2 stated that her door is always locked and has lived there for over 5 years

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Glenn Trueman
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 11/17/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/17/2021

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-20210917163242

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: 11/17/2021

NARRATIVE

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and there has never been any inappropriate interaction with staff and client's in her room.
Staff interviewed stated there has not been any inappropriate interactions with staff and clients.
Stated there has not been a staff Benjamin that has worked here.
Said that Client 2 is in private room and locks the door and there has not been staff and client interactions there.
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.

In regards to the allegation Staff made inappropriate comments to resident, based on interviews conducted and information gathered it was revealed that clients stated that it is the other way around and that Client 1 is the one who is aggressive to staff and can be mean. Staff are nice to Client 1 and will work with him. Clients said that staff have been respectful and never mock or laugh at client's. Client's interviewed had never observed staff mocking or laughing at Client 1.
Client 1 had been heard calling staff bad words and being very rude.
Staff interviewed stated that Client 1 will yell and scream at them and call them names. Will throw papers at staff and had pushed housekeeping staff when attempting to clean room.
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.

NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Glenn Trueman
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 11/17/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/17/2021

LIC9099 (FAS) - (06/04)

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