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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198600539
Report Date: 06/09/2022
Date Signed: 06/09/2022 02:43:27 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
06/06/2022 and conducted by Evaluator Kruz Long
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20220606125641
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: 160DATE:
06/09/2022
UNANNOUNCEDTIME BEGAN:
09:25 AM
MET WITH:Yitzi Meir Teichman (Administrator)TIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Resident injured another resident in care.
Resident was threatened by another resident.
Resident smoking marijuana inside the facility.
Resident has illegal substance.
Staff yells at resident.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Kruz Long conducted an unannounced complaint investigation at the facility. Upon arrival, LPA met with Yitzi Meir Teichman (Administrator) and explained the purpose of the visit.

During today's visit, LPA obtained/reviewed a copy of the staff/client rosters and client records (Physician's report, Needs and services plan), interviewed staff #1 to #7 in the tv room and interviewed clients #1 to #16 in the tv room.

In regards to the allegation: Resident injured another resident in care. Based on allegation details, 5 or 6 years ago a client was injured by another client and was transported to the hospital. Record review did not indicate such an even occurred. Interviews with staff and clients indicate that they do not recall such and event nor have they ever been injured by other clients.

Continue to LIC9099C.....
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Kruz Long
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2022
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-20220606125641
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: 06/09/2022
NARRATIVE
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In regards to the allegation: Resident was threatened by another resident. Interviews with staff and clients revealed that they have witnessed clients threaten other clients but staff immediately intervenes and redirect clients to stop the situation from escalating.

In regards to the allegation: Resident smoking marijuana inside the facility. Interviews with 7 of 7 staff indicate they have never witnessed clients smoking marijuana inside the facility. Interviews with 16 of 16 clients indicate they have never smoke marijuana inside the facility nor have they seen other clients smoke marijuana inside the facility.

In regards to the allegation: Resident has illegal substance. Interviews with 7 of 7 staff indicate there are no illegal substances in the facility. Interviews with 16 of 16 clients indicate they have never used or been in possession of illegal substances in the facility nor have they seen or have knowledge of other clients in possession of illegal substances in the facility.

In regards to the allegation: Staff yells at resident. Interviews with 7 of 7 staff indicate they have never yelled at clients nor have they witness other staff yell at clients. Interviews with 16 of 16 clients indicate staff have never yelled at them nor have they seen staff yell at other clients.

Based on LPA's interviews and record review, the investigation revealed: Although the allegations may have happened or is 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 conducted with Yitzi Meir Teichman and a copy of this report provided.
NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Kruz Long
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2022
LIC9099 (FAS) - (06/04)
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