198600539-12-13-2021-28-AS-LHIS-C9XS7C-20211222123717

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198600539
Report Date: 12/13/2021
Date Signed: 12/13/2021 03:44:49 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
07/21/2021 and conducted by Evaluator Nicol Wesley

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20210721113430

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:	12/13/2021
		UNANNOUNCED	TIME BEGAN:	02:30 PM
MET WITH:	Yitzi Teichman		TIME COMPLETED:	03:45 PM

ALLEGATION(S):

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Clients smoke marijuana while in care.
Staff did not provide client with comfortable room accommodations.
Staff did not prevent clients from engaging in inappropriate interactions.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Nicol Wesley conducted unannounced subsequent complaint investigation regarding the allegations listed above. LPA Wesley met with Administrator Yitzi Teichman and discussed the purpose for todays visit.

The investigation consisted of the following: On 07/27/21 LPA Wesley interviewed Administrator, staff, and residents. LPA also requested a copies of the following documents: staff roster, resident roster, January-March 2021, communicatoin logs/staff notes, ID page and current physicians report for Resident #1(R1). LPA Wesley interviewed staff, residents and attempted to interview Resident #1(R1) and was not successful.

Regarding allegation: Clients smoke marijuana while in care. LPA Wesley interviewed a random selection of staff who said they have never witnessed any residents smoke marijuana in the facility or in their rooms, and also said they have never smelled any aroma throughout the facility. LPA Wesley interviewed a random
Continued on LIC 9099C

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: Rebecca Orendain
NAME OF LICENSING PROGRAM ANALYST: Nicol Wesley
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 12/13/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2021

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-20210721113430

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: 12/13/2021

NARRATIVE

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selection of resident who said they have never witnessed anyone smoking marijuana in the facility rooms or smelled it in the facility halls. Administrator Teichman was interviewed and said he has never smelled anyone smoking marijuana and did say some of the residents may smoke the little cigars in the smoking section but it is not marijuana. LPA Wesley conducted a tour of the physical plant and did not smell any type of aroma that would cause a health and safety concern. LPA attempted to interview resident #1 and their communication device was interrupted and they were not present during the time of visit.

Regarding allegation: Staff did not provide client with comfortable room accommodations LPA Wesley interviewed Administrator Teichman who said that resident #1 complained that the intercom speaker was too loud so they adjusted the volume and resident #1 continued to complain. LPA interview residents who also have rooms close to the intercom and they advised that the sound is not loud and it doesn't bother them because it tells them to go get their medication and reminds them about meal times and also stated that the facility provides accommodations or tries to resolve issues to meet their needs. LPA attempted to interview resident #1 and their communication device was interrupted and they were not present during the time of visit.

Regarding allegation: Staff did not prevent clients from engaging in inappropriate interactions. LPA Wesley interviewed the Administrator who did not observe an altercation with resident #1 and another resident, but did say they were informed that resident was in an altercation with another resident about 5 years ago which resulted in the facility staff having the resident(unknown name) removed from the facility and they no longer reside in the facility. LPA Wesley interviewed a random selection of resident and who stated that the facility staff on duty goes around and does room check, and walks around the facility to make sure everyone is safe. LPA attempted to interview resident #1 several times and was not successful(phone services interrupted) and they were not present during the time of visit.

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.

There are no deficiencies cited. A copy of the LIC 9099/LIC 9099C was given during the exit interview.

NAME OF LICENSING PROGRAM MANAGER: Rebecca Orendain
NAME OF LICENSING PROGRAM ANALYST: Nicol Wesley
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 12/13/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2021

LIC9099 (FAS) - (06/04)

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