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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198600539
Report Date: 09/18/2025
Date Signed: 09/18/2025 04:24:43 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 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
09/12/2025 and conducted by Evaluator Cynthia D Chan
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20250912142827
FACILITY NAME:PICO RIVERA GARDENSFACILITY NUMBER:
198600539
ADMINISTRATOR:JOYCE GARCIAFACILITY TYPE:
735
ADDRESS:6525 ROSEMEAD BLVD.TELEPHONE:
(562) 949-8489
CITY:PICO RIVERASTATE: CAZIP CODE:
90660
CAPACITY:185CENSUS: 171DATE:
09/18/2025
UNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Julia Elias, StaffTIME COMPLETED:
04:30 PM
ALLEGATION(S):
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Staff does not ensure client's medical needs are being met.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Cynthia Chan conducted a complaint investigation on the allegation listed above. LPA arrived unannounced and met with Staff, Julia Elias. The purpose of the visit was explained.

During the visit today, LPA obtained copies of the staff and client rosters and documents for Client #1. LPA interviewed Staff #1 – #4 and Clients #1 - #12. Medications were also reviewed.

The investigation revealed the following:
Allegation - Staff does not ensure client's medical needs are being met. It is alleged that Client #1 (C1) is supposed to have blood drawn monthly for a medication dispensed at the facility. LPA reviewed C1’s medical record and file. LPA observed a physician’s order dated 3/1/25 to get a lab test done monthly.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Cynthia D Chan
LICENSING EVALUATOR SIGNATURE:

DATE: 09/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2025
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 5
Control Number 28-AS-20250912142827
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: PICO RIVERA GARDENS
FACILITY NUMBER: 198600539
VISIT DATE: 09/18/2025
NARRATIVE
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Records showed that C1’s lab work was last completed in March 2025. There were no lab reports from April to August observed in the file. Staff could not confirm if the monthly lab work had been done. Staff stated C1 was not feeling well and was taken to the hospital on 9/9/25 and again on 9/12/25. The hospital determined the client had Lithium Toxicity. Other staff interviewed were not sure if C1 needed to get monthly lab test for Lithium medication. LPA interviewed C1, who was aware that a monthly blood test was needed but could not recall the last time it was done. C1 knows the importance of maintaining good health and would never refuse the lab test. Two (2) other clients interviewed, who need lab work done monthly, stated they get their blood drawn at the facility. The other nine (9) clients interviewed do not require any specific medical needs.

Based on interviews conducted and record review, the preponderance of evidence standard has been met; therefore, the above allegation is found to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division 6 and Chapter 6), are being cited on the attached LIC 9099D.



An exit interview was conducted. The Plan of Correction was reviewed and developed with Staff J. Elias. A copy of this report and appeal rights were provided.
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Cynthia D Chan
LICENSING EVALUATOR SIGNATURE:

DATE: 09/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 28-AS-20250912142827
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: PICO RIVERA GARDENS
FACILITY NUMBER: 198600539
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/18/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/19/2025
Section Cited
CCR
85075(b)
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85075 Health-Related Services (b) The facility shall develop and implement a plan which ensures that assistance is provided to the clients in meeting their medical and dental needs.
This requirement is not met as evidenced by:
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Licensee shall provide the plan to ensure all physician's orders and medical needs are met by POC due date 9/19/25.
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Based on record review and interview, C1 was not taken to get monthly lab work as ordered by the physician which poses a potential health, safety, and personal rights to clients in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Cynthia D Chan
LICENSING EVALUATOR SIGNATURE:

DATE: 09/18/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 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
09/12/2025 and conducted by Evaluator Cynthia D Chan
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20250912142827

FACILITY NAME:PICO RIVERA GARDENSFACILITY NUMBER:
198600539
ADMINISTRATOR:JOYCE GARCIAFACILITY TYPE:
735
ADDRESS:6525 ROSEMEAD BLVD.TELEPHONE:
(562) 949-8489
CITY:PICO RIVERASTATE: CAZIP CODE:
90660
CAPACITY:185CENSUS: 171DATE:
09/18/2025
UNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Julia Elias, StaffTIME COMPLETED:
04:30 PM
ALLEGATION(S):
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Staff mismanages client's medication regimen.
INVESTIGATION FINDINGS:
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13
Licensing Program Analyst (LPA) Cynthia Chan conducted a complaint investigation on the allegation listed above. LPA arrived unannounced and met with Staff, Julia Elias. The purpose of the visit was explained.

During the visit today, LPA obtained copies of the staff and client rosters and documents for Client #1. LPA interviewed Staff #1 – #4 and Clients #1 - #12. Medications were also reviewed.

The investigation revealed the following:
Allegation - Staff mismanages the client's medication regimen. LPA interviewed four (4) staff who stated that the majority of the clients are taking their medications consistently. Staff denied mismanaging any clients’ medication regimen. Staff stated the medications are dispensed during the overnight shift for the next day and are administering medications based on the physician’s orders. There had not been any changes to the way medications are given.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Cynthia D Chan
LICENSING EVALUATOR SIGNATURE:

DATE: 09/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 28-AS-20250912142827
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: PICO RIVERA GARDENS
FACILITY NUMBER: 198600539
VISIT DATE: 09/18/2025
NARRATIVE
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For those who refuse to take it during the time of administering, they are provided prompts, and the clients will usually take their meds within the window period. However, if the client refuses or is out in the community, staff will document those reasons. LPA interviewed (12) clients today. All the clients stated they receive their medications daily by going to the medication room. Clients have no issues regarding staff managing their medications.
LPA checked 11 out of the 12 clients’ medications and did not observe any discrepancies. The medications listed on the Medication Administration Records (MARs) were present. C1’s medications were not available for review since C1 is currently at the skilled nursing facility. However, the MAR log showed that C1 was consistently taking all of the medications.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur; therefore, the allegation is UNSUBSTANTIATED.

An exit interview was conducted with Staff J. Elias. A copy of this report, along with the appeal rights, was provided.
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Cynthia D Chan
LICENSING EVALUATOR SIGNATURE:

DATE: 09/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5