198600539-7-8-2022-28-AS-LHIS-CGVUZX-20220801160215

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198600539
Report Date: 07/07/2022
Date Signed: 07/08/2022 11:05:45 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
07/05/2022 and conducted by Evaluator Noemi Galarza

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20220705084756

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: 169	DATE:	07/07/2022
		UNANNOUNCED	TIME BEGAN:	09:40 AM
MET WITH:	Meir Yitzi Teichman, Administrator		TIME COMPLETED:	04:15 PM

ALLEGATION(S):

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Staff did not administer medication as prescribed.
Staff do not provide safe and comfortable environment when speaking loud and fast to residents on facility speaker.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Galarza conducted an initial 10-Day complaint visit to investigate the above allegations.The purpose of the visit was discussed with Administrator Meir Yitzi Teichman. Supervisor Andrew De Vera assisted with the physical plant inspection.

The investigation consisted of: A physical tour of the facility, room 46, and kitchen was conducted. The intercom sound system was tested. The kitchen was inspected and lunch meal service was observed. Staff (S1-S9) and clients (C1-C16) were interviewed. Client (C1's) file documents [Identification and Emergency Information, Preplacement Appraisal, Physician Report, Psychiatric Notes, Appraisal Needs/Services Plan, monthly food menu [6/5/22 - 7/9/22], Medication Administration Records (June 2022 & July 2022), staff schedule, and client roster were obtained.
NOTE: There were deficiencies observed in the kitchen that are cited in a separate case management report.

See LIC 9099C for report continuation.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Noemi Galarza	TELEPHONE: (323) 981-3974
LICENSING EVALUATOR SIGNATURE:	DATE: 07/07/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2022

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-20220705084756

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: 07/07/2022

NARRATIVE

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Allegation: Staff did not administer medication as prescribed. It is alleged that on July 5, 2022 during medication administration an unidentified med-tech staff dispensed client (C1) it’s four (4) medications in a cup that had a “white powdery substance” on the medication. Client (C1) refused to take the medications because of fear that the white "substance" would harm the client. It is alleged that the client was not administered it's aspirin medication. It is also alleged that C1 found a note that said that staff gave the client “2 big white pills, an overdose” of diabetic medication in 2021 or 2020. Client (C1’s) Medication Administration Record (MAR) listed aspirin 81 mg as an AM medication only; which may be the reason why C1 was not administered that medication. The facility does not have an electronic Medication Administration Records (MAR) system in place. The facility has in place negative charting for medications i.e. staff do not document/initial medication administration on the MAR sheet, unless a client refuses the medication, or receives PRN medication. The June and July MAR's indicated all medications were dispensed as ordered by physicians. Med-tech and administration staff stated C1 is always medication compliant, and has not missed any medications. The NOC shift medication-tech staff pre-pour client medications for the next day. Staff stated that occasionally, when the medications are pop out of the bubble pack the pills chip a little and there may be white small pieces of the medication left in the cup. Two (2) out of sixteen (16) clients interviewed stated they do not get medications as ordered; the rest of the clients interviewed denied the allegation. C1's medications were inventoried and medication records were reviewed. No immediate health issues or discrepancies were observed.

Allegation: Staff do not provide safe and comfortable environment when speaking loud and fast to residents on facility speaker. It is alleged that staff raise the volume when communicating to clients over the new facility speaker system and it is causing distress to clients. On 7/5/2022, staff (S5) spoke fast and in a loud manner over the speaker system, which caused C1 distress and suffering. During today’s visit, the facility intercom speaker system was tested. The speaker’s sound was within normal sound volume. Four (4) out of sixteen (16) clients stated that at times the intercom announcements are too loud, especially in the quieter evening hours. It is alleged that staff (S5-S7) speak in a loud and fast manner on the intercom system. These staff denied the allegation, and stated they have a slightly higher pitch voice that may be construed as loud. Twelve (12) out of sixteen (16) clients stated that they have no issues with staff speech over the intercom system, speaker sound volume, or environment safety concerns. at the facility. The intercom volume is adjustable, with speakers placed throughout the facility common areas and hallways.

Although the allegation(s) may have happened or are valid, there are not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation(s) are UNSUBSTANTIATED.

An exit interview was conducted with Med-Tech Fabiola Padilla. A copy of the report was issued.

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Noemi Galarza	TELEPHONE: (323) 981-3974
LICENSING EVALUATOR SIGNATURE:	DATE: 07/07/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2022

LIC9099 (FAS) - (06/04)

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