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

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198600539
Report Date: 03/22/2022
Date Signed: 03/22/2022 04:25:40 PM

Substantiated


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
03/14/2022 and conducted by Evaluator Alberto Lopez
COMPLAINT CONTROL NUMBER: 28-AS-20220314120914
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: 155DATE:
03/22/2022
UNANNOUNCEDTIME BEGAN:
10:19 AM
MET WITH:Administrator Yitzi TeichmaTIME COMPLETED:
04:31 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff do not prevent residents from smoking in the facility.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Alberto Lopez and Ashley Calderon conducted an unannounced complaint visit regarding the above allegations. LPA met with Administrator Yitzi Teichman and explained the reason for the visit.
The investigation consisted of the following: LPA obtained a client and staff roster, facility house rules which include smoking policy, menu and interviewed Staff #1 – #7 (S1 – S7), and Client #1-#10 (C1 – C10)
5 of 7 staff reported that they have seen client’s smoke in the rooms or hallways of the facility.
7 of 10 clients reported that clients smoke in the facility. LPAs witness one resident smoking in her balcony and entering her room with lit cigarette in her hand. LPA’s observed cigarette bud on the floor of the TV room in the first floor.
Based on the interviews conducted and observations, there was enough supportive evidence to concur with the reported allegation. Therefore, the allegation is SUBSTANTIATED. (See 9099 for details)

Exit Interview was conducted with Administrator Yitzi Teichman. A copy of this report was provided.



Substantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Christine Yee
NAME OF LICENSING PROGRAM ANALYST: Alberto Lopez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2022
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 5
Control Number 28-AS-20220314120914
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/22/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/25/2022
Section Cited
CCR
80072(a)(2)
1
2
3
4
5
6
7
Personal Rights: Health and safety issue. 5 of 7 staff stated they have seen clients somke in the facility. 4 of ten cliients stated they have seen clients smoked in the facility. LPAs observed one cleint walk into her room with a lit cigarette. LPAs oberved cigerette bud on the floor of the TV room.
1
2
3
4
5
6
7
Administrator/Licensee shall remind clients of the house rules.Smoking in the facility is a direct violation of house rules and will not be tolerated. Administrator/Licensee shall post non smoking signs in facility. Administrator will send photos to prove that signs were posted through out the facility.
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
NAME OF LICENSING PROGRAM MANAGER: Christine Yee
NAME OF LICENSING PROGRAM ANALYST: Alberto Lopez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/22/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 5
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
03/14/2022 and conducted by Evaluator Alberto Lopez
COMPLAINT CONTROL NUMBER: 28-AS-20220314120914

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: DATE:
03/22/2022
UNANNOUNCEDTIME BEGAN:
10:19 AM
MET WITH:TIME COMPLETED:
04:31 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff not providing adequate food service to residents.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Alberto Lopez and Ashley Calderon conducted an unannounced complaint visit regarding the above allegations. LPA met with Administrator Yitzi Teichman and explained the reason for the visit.
The investigation consisted of the following: LPAs obtained a client and staff roster, facility house rules including smoking policy, menu and interviewed Staff #1 – #7 (S1 – S7), and Client #1-#10 (C1 – C10)
Cook S1 and assistance S2 stated they have never received complaints about the food. S3-S7 stated they have never heard complaints about the food and denied allegations. C1.2,3,4,6,8,9 and C10 did not collaborate the allegation. C5 stated food is horrible because they spray the pan with nonstick substance that taste like metal. C7 Stated food is bland, dry and small portions. C8 Stated food service not good due to not having “decent” food. C8 stated he ate his meals today. C8 Stated food was good. LPAs toured kitchen and there was enough nonperishable food for 7 days and perishable food for 2 days.
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.

Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Christine Yee
NAME OF LICENSING PROGRAM ANALYST: Alberto Lopez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 28-AS-20220314120914
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: 03/22/2022
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
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.
NAME OF LICENSING PROGRAM MANAGER: Christine Yee
NAME OF LICENSING PROGRAM ANALYST: Alberto Lopez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2022
LIC9099 (FAS) - (06/04)
Page: 5 of 5