198600539-4-25-2022-28-AS-SCOL-CFNV3K-20220623160453

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198600539
Report Date: 04/25/2022
Date Signed: 04/25/2022 12:40:13 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
04/21/2022 and conducted by Evaluator David Sicairos

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20220421163141

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: 163	DATE:	04/25/2022
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Yitzi Teichman; Administrator		TIME COMPLETED:	12:55 PM

ALLEGATION(S):

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Client was sexually assaulted by another client.
Client was pushed by another client.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) David Sicairos conducted an unannounced complaint visit regarding the above stated allegations. LPA met with Administrator Yitzi Teichman and explained the reason for the visit.

The investigation consisted of the following: LPA obtained copies of Client & Staff Rosters. LPA toured the facility including the common areas. LPA reviewed the files of Client #1 (C1) and Client #2 (C2) and obtained copies of the following documents: Identification and Emergency Information Sheets, Appraisal Needs and Services Plan, and Physician's Reports. LPA also interviewed Administrator, Client #1 - Client #7 and Staff #1 - Staff #4.

The investigation revealed the following: in regards to the allegation "client was sexually assaulted by another client", it is alleged that C2 followed C1 into the bathroom and attempted to sexually assault her. C1 was allegedly able to push C2 away to stop the assault. No other details were provided. Interview conducted with C1 confirmed the allegation. C1 indicated there were no witnesses to the alleged incident. C1 indicated that she did not suffer any injuries and was able to stop the sexual assault from occurring by pushing C2 away. (CONTINUED ON 9099C)

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: Stefanie Coronel
NAME OF LICENSING PROGRAM ANALYST: David Sicairos
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 04/25/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/25/2022

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-20220421163141

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: 04/25/2022

NARRATIVE

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C2 denied the allegation during interview. Staff members interviewed indicated that they did not witness the alleged incident. Staff members interviewed indicated that they will report any inappropriate interactions between clients to facility management and will also attempt to de-escalate the situation. Clients interviewed indicated that they did not witness the alleged incident. There are no witnesses, video footage, or police report regarding the alleged incident. Therefore there was insufficient evidence to corroborate with this allegation.

In regards to the allegation "client was pushed by another client", it is alleged that sometime in the beginning of April 2022, C2 pushed C1 while attempting to sexually assault her. No other details were provided. Interview conducted with C1 confirmed the allegation to be true. C2 denied the allegation during the interview. Staff members interviewed indicated that they did not witness the alleged incident. Staff members interviewed indicated that if they witness an altercation between clients they will attempt to stop the altercation and will notify facility management immediately. Facility staff will also contact Law Enforcement and seek medical attention for clients if needed. Clients interviewed indicated that they did not witness the alleged incident between C1 and C2. Clients interviewed indicated that they feel safe at the facility and confirmed that facility staff will intervene during client on client altercations. Therefore there was insufficient evidence to corroborate with this allegation.

Based on statements and interviews conducted with staff, clients, review of client files and facility file records, there was not enough supportive evidence to concur with the reported allegations. 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 held, and a copy of this report was provided.

NAME OF LICENSING PROGRAM MANAGER: Stefanie Coronel
NAME OF LICENSING PROGRAM ANALYST: David Sicairos
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 04/25/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/25/2022

LIC9099 (FAS) - (06/04)

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