198600539-3-9-2022-28-AS-RORN-CHUV94-20220901161342

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198600539
Report Date: 03/09/2022
Date Signed: 03/09/2022 04:09:51 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
08/30/2021 and conducted by Evaluator Jose Villalobos

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20210830131135

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:	03/09/2022
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Administrator Yitzi Teichman		TIME COMPLETED:	03:15 PM

ALLEGATION(S):

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Staff speak inappropriately to residents
Staff mismanaged resident's medication
Staff mismanaged resident's funds
Staff scream at residents through facility intercom
Residents are allowed to smoke inside the facility

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jose Villalobos conducted a subsequent complaint investigation for the allegations listed above. LPA Villalobos met with Administrator Yitzi Teichman and the purpose of the visit was discussed.

On 9/7/2021, LPA Villalobos obtained a copy of the staff and client rosters, conducted a tour of the physical plant and interviewed the Staff #1-#2 (S1-S2) and clients #1-4 (C1-C4). LPA also reviewed and collected copies of C1's client file.

During todays visit, LPA Villalobos interviewed Staff#3-#7 (S3-S7) and clients#5-14 (C5-C14).

The investigation revealed the following: In regards to the allegation "Staff speak inappropriately to residents" It was alleged that staff yelled at C1. (7) of (7) staff interviewed denied the allegation. (13) of (14) clients interviewed could not corroborate 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: 03/09/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/09/2022

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-20210830131135

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: 03/09/2022

NARRATIVE

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Interviews show that there was dispute between C1 and S2 where S2 believed C1 was taking a clipboard that did not belong to C1. C1 explained the situation and S2 did not pursue any further. According to S2 there was no yelling involved. Based on the interviews conducted and observations, there was not enough supportive evidence to concur with the reported allegation. 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.

In regards to the allegation "Staff mismanaged resident's medication" It was alleged that C1 received their medication with wood particles on it. (7) of (7) staff interviewed denied the allegation. (13) of (14) clients interviewed could not corroborate the allegation. Interviews did not show that the C1s medication was damaged or could have been contaminated. LPA was not provided a date on when this incident had occurred. LPA observed C1's medication and did not find contaminated medications. C1 stated they still took their medication even though something did not look right. Based on the interviews conducted and observations, there was not enough supportive evidence to concur with the reported allegation. 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.

In regards to the allegation "Staff mismanaged resident's funds" It was alleged that staff were withholding extra stimulus checks from C1. (7) of (7) staff interviewed denied the allegation. (13) of (14) clients interviewed could not corroborate the allegation. Interviews show that C1 was told by their family that C1 should have gotten the Golden State Stimulus in 2021. C1 stated they do not do taxes; therefore, it was concluded that they would not qualify for it. C1 did receive their stimulus first and second stimulus by the time of the initial visit and was up to date. Based on the interviews conducted and observations, there was not enough supportive evidence to concur with the reported allegation. 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.

Continued on LIC 9099-C

NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Jose Villalobos
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 03/09/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/09/2022

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 28-AS-20210830131135

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: 03/09/2022

NARRATIVE

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In regards to the allegation "Staff scream at residents through facility intercom" It was alleged that staff scream into the intercom system when calling clients. (7) of (7) staff interviewed denied the allegation. (13) of (14) clients interviewed could not corroborate the allegation. Interviews do not show that staff yell into the intercom system. LPA toured the physical plant and heard the intercom system during the visit and it did not sound as though the staff were screaming into it. Based on the interviews conducted and observations, there was not enough supportive evidence to concur with the reported allegation. 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.

In regards to the allegation "Residents are allowed to smoke inside the facility" It was alleged that clients smoke inside the facility and staff do not address the issue. (7) of (7) staff interviewed denied the allegation. (13) of (14) clients interviewed could not corroborate the allegation. Interviews show that clients are repeatedly reminded of the facility rules of no smoking inside the facility. There are designated areas for clients to smoke outdoors and in the patio areas. When staff observe anyone trying to smoke inside, they address the issue and remind clients to go outside. Interviews do not show that staff allow clients to smoke inside. LPA observed the facility house to verify. Based on the interviews conducted and observations, there was not enough supportive evidence to concur with the reported allegation. 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.

No deficiencies cited on todays visit. Exit Interview was conducted with Administrator Yitzi Teichman 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: 03/09/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/09/2022

LIC9099 (FAS) - (06/04)

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