198600539-4-21-2022-28-AS-FFIS-CE5R52-20220505124225

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198600539
Report Date: 04/21/2022
Date Signed: 04/21/2022 03:59:49 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
04/12/2022 and conducted by Evaluator Jose Villalobos

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20220412101113

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: 161	DATE:	04/21/2022
		UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Administrator Yitzi Teichman		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Residents not provided dignity and respect.

Facility not providing a comfortable temperature for residents in facility.

INVESTIGATION FINDINGS:

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

The following was conducted on todays visit, LPA interviewed Staff #1-#6 (S1-S6) and Clients #1-#15 (C1-C15). LPA toured the physical plant and room #4. Staff #7 (S7) could not be interviewed as they no longer work at this facility.

The investigation revealed the following: Regarding the allegation "Residents not provided dignity and respect" it was alleged staff #7 ignored and shut the door in C1's face. (6) of (6) staff interviewed denied the allegation. (15) of (15) clients interviewed could not corroborate the allegations. Interviews show that S7 has not worked or been in the facility in over 5 years. C1 denied the allegations and could not corroborate the allegation....

Continued on 9099C.

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Jose Villalobos
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 04/21/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2022

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-20220412101113

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: 04/21/2022

NARRATIVE

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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 "Facility not providing a comfortable temperature for residents in facility" it was alleged that the facility kept the heater on when it was already 90 degrees outside making it uncomfortable to the clients in care. (6) of (6) Staff interviewed denied the allegation. (14) of (15) clients interviewed could not corroborate the allegation. LPA was not provided on specific dates when the allegation would have occurred. Interviews with staff show that they will adjust the temperature for the facility to keep it comfortable to clients. Interviews with clients show that the staff will always adjust temperatures when needed. LPA observed that the temperature throughout the facility was within regulation at the time of this visit. 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.

Exit Interview was conducted 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: 04/21/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2022

LIC9099 (FAS) - (06/04)

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