198600539-2-9-2022-28-AS-FFIS-CEDSEU-20220513134918

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198600539
Report Date: 02/09/2022
Date Signed: 02/09/2022 03:15:34 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
01/31/2022 and conducted by Evaluator Jose Villalobos

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20220131092845

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: 170	DATE:	02/09/2022
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Administrator Yitzi Teichman		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Staff handled resident in a rough manner
Staff mismanaged resident's medication
Staff spoke inappropriately to resident
Staff served cold food to residents
Staff listen to resident's personal telephone calls

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 interviewed clients #1-#14 (C1-C14), and interviewed Staff #1-#7 (S1-S7) between 9:40am-12pm. LPA reviewed Client #1 file between 12pm-12:30am. LPA toured the physical plant and observed the food served for lunch between 12:30pm-1:15pm.

The investigation revealed of the following: In regards to the allegation "Staff handled resident in a rough manner" it was alleged that C1 was jumped by facility staff.(7) of (7) staff interviewed denied the allegation. (14) of (14) clients interviewed could not corroborate the allegation. LPA was not provided with a time or date when C1 was handled in a rough manner by staff....

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: 02/09/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2022

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-20220131092845

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: 02/09/2022

NARRATIVE

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Interview with C1 does not state that staff ever roughed up C1 but that C1 sometimes feels pain and thinks its staff causing needle-like sharp pain on their body. Based on interviews conducted, 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 mismanaged resident's medication" it was alleged that facility staff withhold medication Mylanta from C1. (7) of (7) staff interviewed denied the allegation. (13) of (14) clients interviewed could not corroborate the allegation. Review of C1's file shows that Mylanta is a PRN medication that is to be taken twice a day as needed. LPA reviewed a note with FAX confirmation that the medication ran out on 2/8/22 and asked for a refill. The refill arrived at the time of the visit on 2/9/22 and LPA observed it. Interviews show that C1 requests this medication almost daily and staff will provide it to C1 which is how it ran out on 2/8/22. Staff requested a refill at a timely manner because C1 chooses to take the PRN medication. Based on observation, review of documents, and interviews conducted., 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 spoke inappropriately to resident" it was alleged facility staff will say inappropriate and evil things to C1. (7) of (7) staff interviewed denied the allegation. (13) of (14) clients interviewed could not corroborate the allegation. Review of C1's file shows that C1 has a diagnosis and history of auditory hallucinations and paranoia. Interviews state that C1 tends to walk past staff and clients and believe they are saying bad things about C1 when really no one has said a thing to C1. C1 stated to hear the bad things in her head and that staff and clients of the facility could not be trusted. Based on interviews, files reviewed, and observations, 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: 02/09/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2022

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20220131092845

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: 02/09/2022

NARRATIVE

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The investigation revealed of the following: In regards to the allegation "Staff served cold food to residents" it was alleged that the food of the facility is cold. (7) of (7) staff interviewed denied the allegation. (13) of (14) clients interviewed could not corroborate the allegation. Interviews show that food that is supposed to be served warm is served warm and not cold. LPA was not provided with examples or instances where the food of the facility was served cold. LPA observed clients eat lunch during the visit and it was not cold. Based on interviews and observations, 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.

The investigation revealed of the following: In regards to the allegation "Staff listen to resident's personal telephone calls " it was alleged that facility staff listen into C1's phone calls from another telephone line..(7) of (7) staff interviewed denied the allegation. (13) of (14) clients interviewed could not corroborate the allegation. Interviews show that C1 uses the facility phone. The facility phone line is not connected to any other phone in the facility so there would be no way for staff or any other person to pick up a different phone and listen into any conversations. LPA observed this to be correct as it was tested. Based on interviews and observations, 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 was conducted 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: 02/09/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2022

LIC9099 (FAS) - (06/04)

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