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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198600539
Report Date: 03/10/2022
Date Signed: 03/10/2022 04:54:17 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
02/28/2022 and conducted by Evaluator Nune Margaryan
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20220228090356
FACILITY NAME:PICO RIVERA GARDENSFACILITY NUMBER:
198600539
ADMINISTRATOR:MEIR SHAUL YITZI TEICHMANFACILITY TYPE:
735
ADDRESS:6525 ROSEMEAD BLVD.TELEPHONE:
(562) 949-8489
CITY:PICO RIVERASTATE: CAZIP CODE:
90660
CAPACITY:185CENSUS: 160DATE:
03/10/2022
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Administrator Yitzi Teichman
and Assistant Administrator Andrew De Vera		TIME COMPLETED:
05:00 PM
ALLEGATION(S):
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Staff are not providing a safe and healthful environment for resident in care
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Nune Margaryan conducted an unannounced 10 day complaint visit to investigate the allegation listed above. LPA met with Administrator Yitzi Teichman and explained the purpose of visit.

The investigation consisted of the following: LPA Margaryan obtained a copy of the staff roster, clients roster, Client #1's (C1's) Identification and Emergency Information/Face Sheet, Physician Report, Appraisal/Needs and Services Plan and interviews with Administrator, Staff #1 – Staff # 5 (S1-S5), Client #1 – Client #16
(C1 - C16).

Continue 9099C
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Nune Margaryan
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2022
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-20220228090356
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: 03/10/2022
NARRATIVE
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Regarding the allegation that “Staff are not providing a safe and healthful environment for resident in care”, it was alleged that client at the facility follows C1, pulled pants down, and showing itself to C1.
C1 talked to staff but staff have not done anything in regards to this matter. Administrator and staff interviewed denied the allegations. No body at the facility has seen the client pulling pants down, following C1 and showing itself to C1 or others. Administrator stated when staff see any clients pulling pants down or wearing inappropriately, they immediately address it and redirect clients. LPA interviewed sixteen (16) clients and fifteen (15) clients denied the allegation and reported they never seen any clients walk around with pants down and following others. They stated that staff are providing a safe and healthful environment for clients.

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 allegations are Unsubstantiated.

An exit interview was conducted, and a copy of this report was provided to the Assistant Administrator.
NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Nune Margaryan
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2