198600539-5-17-2022-28-AS-FFIS-CF6LWB-20220607090648

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198600539
Report Date: 05/16/2022
Date Signed: 05/17/2022 08:19:54 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
05/09/2022 and conducted by Evaluator Jose Villalobos

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20220509162725

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:	05/16/2022
		UNANNOUNCED	TIME BEGAN:	01:15 PM
MET WITH:	Administrator Yitzi Teichman		TIME COMPLETED:	04:10 PM

ALLEGATION(S):

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Staff failed to provide a safe and comfortable environment for resident
Staff failed to treat resident with dignity and respect
Staff inappropriately spoke to resident

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-#5 (S1-S5) and Clients #1-#12 (C1-C12). LPA toured the physical plant.

The investigation revealed the following: Regarding the allegation "Staff failed to provide a safe and comfortable environment for resident" it was alleged that S2 and another client threatened C1. (5) of (5) staff interviewed denied the allegation. (11) of (12) clients interviewed could not corroborate the allegations. Interviews show that C1 had an argument with another client outside the facility and S2 arrived after the argument. There was no proof provided to LPA that S2 and the other client threatened C1. C1 did not want to provide LPA with the other clients name....

Continued on LIC 9099-C

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Jose Villalobos
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/16/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2022

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-20220509162725

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: 05/16/2022

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, "Staff failed to treat resident with dignity and respect" it was alleged that S2 mocked C1. (5) of (5) staff interviewed denied the allegation. (11) of (12) clients interviewed could not corroborate the allegations. Interviews do not show that S2 mocks or disrespect's any of the clients in care. LPA was not provided with proof that S2 mocked C1. LPA did not observe S2 mocking any clients or not treating them with dignity and respect. 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, "Staff inappropriately spoke to resident" it was alleged that S2 cursed at C1 and S3 called C1 a brat. (5) of (5) staff interviewed denied the allegation. (11) of (12) clients interviewed could not corroborate the allegations. Interviews show that staff have not cursed at C1 and it is usually the other way around. Client interviews show that staff have not spoken inappropriately to the clients in care and supervision. LPA did not observe any staff speak inappropriately to clients in care. 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: 05/16/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2022

LIC9099 (FAS) - (06/04)

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