198600539-1-26-2022-28-AS-LHIS-CDDQVG-20220411123020

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198600539
Report Date: 01/26/2022
Date Signed: 01/26/2022 04:26:04 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
01/20/2022 and conducted by Evaluator Noemi Galarza

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20220120085636

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:	01/26/2022
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Meir Yitzi Teichman, Administrator		TIME COMPLETED:	04:35 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

The heater is not turned on at night.
The thermostat in resident's room is not working.
Someone is leaving the residents back door open.
Staff is playing mind games with the resident.

INVESTIGATION FINDINGS:

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

Licensing Program Analyst (LPA) Galarza conducted an initial complaint visit to investigate the above allegations. The purpose of the visit was discussed with Administrator Meir Yitzi Teichman.

The investigation consisted of the following: A physical plant tour of facility resident rooms and common areas was conducted. The heating and facility temperature was comfortable at the time of the visit. Staff (S1- S5) and residents (R1- R13)were interviewed. Copies of resident (R1's) file documents [Face Sheet, Physician Report, and Appraisal] staff and resident rosters were obtained.

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: 01/26/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2022

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-20220120085636

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: 01/26/2022

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: "The heater is not turned on at night." Based on interviews conducted the findings indicate that the facility has not had any issues with heating in recent months. It is alleged that during Christmas the heater was not working, and after it was repaired staff started turning the heater on in the mornings, but turned it off at night. All staff interviewed stated the heating system was in working condition during Christmas, and it was not in disrepair. The Maintenance Director was interviewed, and stated that there are 18 thermostats in the 2-story building, all of which are maintained at 72 degrees Fahrenheit day and night. Maintenance Director checked R1's room temperature during Christmas and did not find heating issues. Staff reported that there are always some residents that feel the temperature in the facility is too cold, and some feel the temperature is too hot. A total of 13 residents were interviewed. Eight (8) out of 13 residents reported no issues with heating at the facility or in their rooms. LPA conducted a physical plant tour of the common areas and resident rooms. The resident room temperature was comfortable within Title 22 regulation between a minimum of 68 degrees F and a maximum of 85 degrees F.

Allegation: "The thermostat in resident's room is not working." Based on physical plant inspection of Resident (R1's) room the allegation is not supported. There is no thermostat inside R1's room or other resident rooms. There are locked thermostats throughout the facility in hallways and common areas only accessible to Maintenance staff. Twelve (12) out of 13 residents interviewed stated there is no thermostat in their room. Staff stated that R1 frequently complains about room temperature. The Maintenance staff is sent to check the room temperature of residents that complain about heating or cooling issues.

Allegation: "Someone is leaving the residents back door open." It is alleged that someone is entering resident (R1's) room through the rear sliding door and leaving it opened. This door leads to the outside balcony patio area. R1's roommate was interviewed and denied this allegation. R1's roommate reported no issues regarding other residents entering resident's rooms without permission. Staff interviewed stated that R1's sliding door is always locked because R1 always wants it locked. Housekeeping staff stated that R1's sliding door is never left opened. LPA observed the sliding door closed and locked at the time of the room inspection.

See LIC 9099C for report continuation.

NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Noemi Galarza
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 01/26/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2022

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 28-AS-20220120085636

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: 01/26/2022

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 is playing mind games with the resident." Based on interviews conducted this allegation could not be supported. A total of 13 residents were interviewed. Twelve (12) out of 13 residents denied this allegation and stated they are treated well by staff. Staff interviews revealed that resident (R1's) mental disability cause the resident to misinterpret conversations and/or staff directives as "mind games". All staff denied allegation. There was insufficient evidence to support this allegation.

Based on interviews conducted and record review the findings indicate that 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.

Exit interview 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: 01/26/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2022

LIC9099 (FAS) - (06/04)

Page: 3 of 3