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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198600539
Report Date: 12/28/2021
Date Signed: 12/28/2021 04:39:20 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
12/20/2021 and conducted by Evaluator Jose Villalobos
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20211220134228
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:
12/28/2021
UNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Administrator Yitzi Teichman TIME COMPLETED:
04:45 PM
ALLEGATION(S):
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Staff unlawfully evicted a client
Staff mishandle the clients mail while in care
Staff speak inappropriately towards a client
Client is providing care and supervision to other clients
Staff behavior poses as a risk to the clients
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. The purpose of the visit was discussed.

The investigation consisted of the following: On today's visit, LPA reviewed Client #1 and Client #2's file between 11:45am-12:30pm. LPA interviewed client #1-#16 (C1-C16), and interviewed Staff #1-#7 (S1-S7) between 12:45pm-3pm.

The investigation revealed of the following: In regards to the allegation "Staff unlawfully evicted a client" it was alleged that C1 is being unlawfully being evicted. (7) of (7) staff interviewed denied the allegation. (15) of (16) clients interviewed could not corroborate the allegation. This allegation was investigated under complaint control #28-AS-20210920121641 and concluded unsubstantiated. LPA Villalobos was not provided with further information that was not discussed or reviewed on previous complaint; therefore, there are no changes to the allegation...

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: 12/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/28/2021
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 3
Control Number 28-AS-20211220134228
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: 12/28/2021
NARRATIVE
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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.

In regards to the allegation "staff mishandle the clients mail while in care" it was alleged that on 11/17/21 staff told C1 they had mail and when C1 went to get their mail later in the day, staff told C1 there was no mail for them. (7) of (7) staff interviewed deny the allegation. (15) of (16) clients interviewed could not corroborate the allegation. Interviews show that staff will keep all client mail in the medication room and pass it out to them as they come for their meds. Staff will also announce via the PA system that clients can pick up their mail throughout the day. LPA observed the location where staff keep the client mail. Interviews with clients did not show that the facility staff had been losing or mishandling mail. 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.

In regards to the allegation "Staff speak inappropriately towards a client" it was alleged that S2 shouted profanity at C1 when C1 asked for toiletries on 1/28/21. (7) of (7) staff interviewed denied the allegation. (15) of (16) clients interviewed could not corroborate the allegation. There were no witnesses to the incident. Interviews show that C1 tends to shout and speak disrespectfully to staff and clients of the facility. It has not been observed or seen that staff will speak inappropriately to C1. LPA has not observed staff speak inappropriately to clients in care. 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.

In regards to the allegation "Client is providing care and supervision to other clients" it was alleged that C2 is a client and at the same time working in the facility providing care and supervision to other clients. (7) of (7) Staff interviewed denied the allegation. (15) of (16) clients interviewed denied the allegation. Interviews show that C2 volunteers to help around the facility and is always supervised by S3. C2 denied being part of the staff and informed LPA that the tasks C2 volunteers for are mopping or sweeping and each time S3 is present. C2 stated that the volunteer work helps relieve the thoughts of suicide and self harm. C2 does not perform tasks for other clients or provide supervision. Review of C2's Needs and Services Plan notes that C2 does volunteer work for the facility but does not replace any of the staff. Review of documents also show that C2 is not part of the facilities staff roster or part of their payroll. 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.
Continued on LIC 9099-C
NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Jose Villalobos
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 12/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/28/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 28-AS-20211220134228
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: 12/28/2021
NARRATIVE
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In regards to the allegation "Staff behavior poses as a risk to the clients" it was alleged that the overall behavior of the staff is harmful and pose a risk to the clients in care. (7) of (7) Staff interviewed denied the allegation. (15) of (16) clients interviewed could not corroborate the allegation. Interviews do not show that staff behavior poses a risk to the clients in care. Client interviews show that staff are provided the basic needs and services to clients and are available to answer their questions or help when asked. LPA did not observe any staff behavior posing a risk to the clients in care at the time of this visit. 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 conducted with Staff Adam Greco and 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: 12/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/28/2021
LIC9099 (FAS) - (06/04)
Page: 3 of 3