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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198600539
Report Date: 03/25/2022
Date Signed: 03/25/2022 11:37:35 AM

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
03/18/2022 and conducted by Evaluator Tony Vasallo
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20220318091032
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:
03/25/2022
UNANNOUNCEDTIME BEGAN:
08:55 AM
MET WITH:Assistant Administrator, Andrew De VeraTIME COMPLETED:
11:50 AM
ALLEGATION(S):
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Facility staff are discriminating against a client.
Facility staff are failing to meet client’s needs.
Facility staff inappropriately speak to client.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Vasallo conducted a complaint visit to investigate the allegations listed above. LPA met with Assistant Administrator, Andrew De Vera and explained the reason for the visit.

The investigation consisted of the following: Interviews were conducted with 11 residents and 4 staff. The facility was toured.

The investigation revealed the following: Allegation - Facility staff are discriminating against a client. 10 out of the 11 clients interviewed did not corroborate the allegation. Client #1 (C1) indicated he/she has been discriminated against, but could not provide any details about the staff involved or the details of the discrimination. Interviews conducted with staff also did not corroborate the allegation. Based on the information obtained, the allegation is unsubstantiated.

Continued on 9099C.
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Tony Vasallo
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/25/2022
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-20220318091032
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: 03/25/2022
NARRATIVE
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Allegation - Facility staff are failing to meet client’s needs. The complaint did not mention any other details. 10 out of the 11 clients interviewed did not corroborate the allegation. Clients reported getting their medications on time and seeing the physician regularly. C1 indicated facility does not met his/her needs, but C1 did not provide any details. Staff interviewed denied the allegation and did not have anything else to report regarding the allegation. Based on the information obtained, the allegation is unsubstantiated.

Allegation - Facility staff inappropriately speak to client. Allegedly staff yell and cuss at clients. 10 out of the 11 clients interviewed did not corroborate the allegation. Clients had never experienced staff be unprofessional. Many of the clients described the staff as "good". C1 indicated that staff have made false accusations against him/her, but C1 did not go into detail about the names of staff or what the accusations were about. Staff interviewed denied the allegation. Staff have never witnessed other staff be inappropriate with clients. Based on the information obtained, the allegation is unsubstantiated.

Although the allegations 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 allegations are unsubstantiated.

Exit interview held. A copy of the report was provided.
NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Tony Vasallo
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/25/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2