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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198600539
Report Date: 12/13/2021
Date Signed: 12/13/2021 03:44:02 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
09/20/2021 and conducted by Evaluator Nicol Wesley
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20210920121641
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: 168DATE:
12/13/2021
UNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Yitzi TeichmanTIME COMPLETED:
02:30 PM
ALLEGATION(S):
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Unlawful eviction.
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. LPA Wesley met with Assistant Manager Julia Elias

The investigation consisted of the following: On 09/30/21 LPA Wesley interviewed Assistant Manager Julia Elias, Administrator Yitzi Teichman and attempted to interview Resident #1(R1). LPA requested the following documents: staff roster, resident roster, eviction notices issued for the month of September 2021, communicatoin logs/staff notes, ID page and current physicians report for Resident #1(R1).

Regarding allegation: Unlawful eviction:


Please see 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)
Page: 1 of 2
Control Number 28-AS-20210920121641
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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Regarding allegation: During interviews with the Administrator Teichman, LPA was informed that resident #1 often becomes violent and screams and yells obscenities to women staff and residents. Resident #1 was verbally reminded that if they continued to violate the house rules and harass staff and residents they would be given a 30 day eviction notice. It was also communicated that resident #1 has not paid their rent for months. During the investigation it was also communicated that on 09/03/2021 Administrator Teichman attempted to hand deliver a 30 day notice to resident #1 for failure to pay rent and failure to comply with the facility house rules and LPA was informed that resident #1 became angry at the Administrator and yelled for him to remove himself away from his door. Staff were also interviewed and stated that resident #1 does not allow anyone into their room and always yells and curses at them. LPA Wesley attempted to contacted resident #1 through the communication source that was provided and received an email that contained a copy of a 30 day notice dated 09/01/2021 and other documents with that relates to encounters that occurred in the 2020 years with a previous Administrator. Resident #1 also communicated that they were never handed the 30 day eviction notice and it was placed underneath their bedroom door. There were was no additional documents received that pertains to the current complaint allegation. Based on the interviews and the investigation, it appears that there was not sufficient evidence to support the allegation: Unlawful Eviction.

Although the allegations may have happened or are valid, there are not a preponderance of evidence to prove the alleged violations did or did not occur, therefore all the allegations are UNSUBSTANTIATED. There are no deficiencies cited.

A copy of this LIC 9099/LIC 9099C was issued 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)
Page: 2 of 2