198600539-12-1-2021-28-AS-LHIS-C9NPPH-20211213102933

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198600539
Report Date: 12/01/2021
Date Signed: 12/01/2021 12:50:07 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
09/17/2020 and conducted by Evaluator Noemi Galarza

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20200917104623

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:	12/01/2021
		UNANNOUNCED	TIME BEGAN:	11:30 AM
MET WITH:	Meir Yitzi Teichman, Administrator		TIME COMPLETED:	12:55 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff speak inappropriately to resident(s).

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Galarza conducted a subsequent complaint visit to deliver findings on the above allegation. The purpose of the visit was discussed with Administrator Meir Yitzi Teichman.

The investigation consisted of the following: On 9/23/2020, due to the situation surrounding the Coronavirus Disease 2019 (COVID-19), and to implement mitigation measures staff (S1- S4) were interviewed telephonically. On 11/9/2021, a subsequent visit was conducted in which LPA toured the physical plant and interviewed clients (C1-C10). The following documents were obtained: client (C1's) Identification and Emergency Information/Face Sheet, Physician Report, Appraisal/Needs and Services Plan, LIC 500 Personnel Report, staff phone number list, and client roster. During today's visit, LPA interviewed client (C11).

See LIC 9099C for report continuation.

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Noemi Galarza
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 12/01/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/01/2021

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-20200917104623

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: 12/01/2021

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Allegation: "Staff speak inappropriately to resident(s)." It is alleged that on 9/16/2020 during the passing out of night time medications staff (S1) was overheard using bad language towards resident (C11). Staff (S1) is accused of yelling at residents while passing out medications. All staff denied speaking inappropriately to clients, or knowledge of staff (S1) addressing client (C11) in an appropriate manner. Staff (S1) denied the allegation and stated it has never spoken to any clients in an inappropriate manner. Staff interviews reported that there is a resident at the facility that has noise level sensitivity, and misconstrues conversations and tone of voice. This facility serves the mentally disabled adults.

Based on interviews conducted 11 out of 11 clients stated that staff (S1) is courteous, treats clients well, and has not been heard cussing at clients in care. Client (C11) stated that staff (S1) is always nice and has never been rude or impolite. There is no supporting evidence to prove the allegation.

Based on interviews conducted there is insufficient information to support the allegations. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is Unsubstantiated.

Exit interview was conducted with Administrator Meir Yitzi Teichman. A copy of the report was issued.

NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Noemi Galarza
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 12/01/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/01/2021

LIC9099 (FAS) - (06/04)

Page: 2 of 2