<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198600539
Report Date: 02/16/2022
Date Signed: 02/16/2022 12:52:35 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
11/13/2019 and conducted by Evaluator Angelica Rea
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20191113111431
FACILITY NAME:PICO RIVERA GARDENSFACILITY NUMBER:
198600539
ADMINISTRATOR:DOMINGUEZ, SANTOSFACILITY TYPE:
735
ADDRESS:6525 ROSEMEAD BLVD.TELEPHONE:
(562) 949-8489
CITY:PICO RIVERASTATE: CAZIP CODE:
90660
CAPACITY:185CENSUS: 170DATE:
02/16/2022
UNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Mary MarquezTIME COMPLETED:
01:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff failed to keep the facility free from pests
Staff failed to ensure clients are being properly fed
Staff failed to safeguard client's personal belongings
Staff failed to prevent clients from harming another client while in care
Staff is unlawfully evicting client
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Angelica Rea conducted another visit to deliver an amended report for complaint report delivered on 5/9/21, to include additional information.

The investigation consisted of interviews with Staff #1 - Staff #4, and Resident #2- Resident #11, and review of specific documents from Resident #1's file. Regarding the allegation that Staff failed to keep the facility free from pests, staff interviewed denied the allegation. They stated that they do not currently have a pest control problem at the facility. Residents interviewed were unable to corroborate the allegation. They stated that the facility does not have a problem with pests.

Regarding the allegation that Staff failed to ensure clients are being properly fed, Staff interviewed denied the allegation. They stated that the facility always has a sufficient amount of food. Residents interviewed were unable to corroborate the allegation. They stated that they always receive a sufficient amount of food. LPA observed the facility food supply, and observed that the facility had a sufficient amount of perishable and non perishable food on 5/9/21.
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Angelica Rea
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 02/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/16/2022
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 2
Control Number 28-AS-20191113111431
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: 02/16/2022
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
Regarding the allegation that Staff failed to safeguard client's personal belongings. Staff interviewed denied the allegation. They stated that clients belongings are safeguarded at the facility, and they have not received that complaint from residents. Resident interviewed were unable to corroborate the allegation. They stated that their belongings are safeguarded at the facility.

Regarding the allegation that Staff failed to prevent clients from harming another client while in care, staff interviewed denied the allegation. Staff stated that if they see clients attempting to harm another client, they will try to prevent it from happening. Residents interviewed were unable to corroborate the allegation. They stated that staff do attempt to break up fights between residents.

Regarding the allegation that Staff is unlawfully evicting client, Staff interviewed denied the allegation. They stated that Resident #1 violated the house rules. LPA reviewed Resident #1's eviction notice, and observed that it complied with Title 22 regulations. LPA was unable to interview Resident #1. Resident #1 no longer lives at the facility, and a phone number was not available to contact Resident #1.

Based on LPA's observations and interviews, investigation revealed: Although the allegation(s) may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation(s) are unsubstantiated.

No Deficiencies cited under California Code of Regulations Title 22. Exit interview conducted, and a copy of report was provided to Administrator, Yitzi Teichman.
NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Angelica Rea
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 02/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/16/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2