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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198600539
Report Date: 06/21/2022
Date Signed: 06/21/2022 02:27:48 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
08/02/2021 and conducted by Evaluator Christine Wong
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20210802085941
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: 166DATE:
06/21/2022
UNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Andrew DeVera TIME COMPLETED:
02:50 PM
ALLEGATION(S):
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Clients engage in illegal drug behavior while in care
Staff do not properly maintain the facility
Staff do not keep the facility free from mold
Facility intercom is at a high decibel level
Staff threaten the clients while in care
Staff disclose clients personal information
Staff mishandles clients medications while in care
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Christine Wong conducted a subsequent complaint visit to address the above allgations and LPA met with Assistant Administrator Andrew DeVera and explained the reason of the visit and assisted LPA with the complaint visit too.

The investigation consisted of the following: On 8/3/21, LPA Spencer conducted the inital 10 days complaint visit and obtained a copy of the staff and client rosters, conducted a tour of the physical plant and interviewed the administrator and clients #1-7 (C1-C7). On today's visit, LPA Wong also interview additional 10 clients (C8-C17) and 8 staff (S1-S8) and reviewed clients' medication and toured the laundry room and kitchen and the trash can back in the parking lot.

The investigation revelaed of the folliowing: Allegation#1 "Clients engage in illegatl drug behavior while in care." LPA interviewed 17 clients and 11 out of 17 clients denied the allegation.
(See LIC 9099C for continuation)
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Christine Yee
NAME OF LICENSING PROGRAM ANALYST: Christine Wong
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/21/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 6
Control Number 28-AS-20210802085941
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: 06/21/2022
NARRATIVE
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Some clients did report there are clients in the facility who smoke marijuana which is a legalized drug. They can always smell it. LPA interviewed staff and staff did smell clients smoked marijuana in the facility but they would ensure the clients are not mixed with the medication and also ensure they cannot smoke inside their room, staff would do random room check and won't explore to other clients too. For other illegal drugs, staff denied the allegation and did not observe any illegal drug behavior in the faciltiy. Based on interviews and observations, although the allegation may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Allegation#2 "Staff do not properly maintain the facility." LPA interviewed 17 clients and all denied the allegation. The clients reported the facility is clean and staff are maintained the facility pretty good. The staff tried their best to keep the facility clean. LPA interviewed the staff and reported that they are trying their best to keep the facility clean and fix the things that are broken as soon as possible but some of the clients whom they cannot control. They can only talk to them and redirect them. Based on interviews and observations, although the allegation may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Allegation#3 "Staff do not keep the facility free from mold" LPA interviewed 17 clients and 15 out of 17 clients denied the facility has mold in the facility. The clients reported they never seen mold in the facility. LPA interviewed 8 staff and 6 out of 8 staff reported the facility does not have any mold. Staff reported even they have it but nothing serious or bad, just a little bit and they fix it right away. Based on interviews and observations, although the allegation may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Allegation#4 "Facility intercom is at a high decibel level" LPA interviewed 17 clients and 11 out of 17 clients denied the allegation and reported the facility intercom is not loud at all. The clients reported it depends on whom speak on the intercom. Its because some staff are loud and some has a very soft voice and sometimes clients cannot hear at all. Also it depends on the location too, sometimes clients cannot hear the staff called them in their rooms. LPA interviewed staff and reported that there's only one client always reported the facility intercom are too loud. Staff stated that some clients even complained they cannot hear the staff call them for medication or visitors. Staff also indicated that the facility intercom is already in the lowest volume. Based on interviews and observations, although the allegation may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.


NAME OF LICENSING PROGRAM MANAGER: Christine Yee
NAME OF LICENSING PROGRAM ANALYST: Christine Wong
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/21/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 6
Control Number 28-AS-20210802085941
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: 06/21/2022
NARRATIVE
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Allegation#5 "Staff threaten the clients while in care." LPA interviewed the 17 clients and all clients denied the allegation. All clients reported staff are nice to them and no staff ever threatened them. LPA interviewed staff and all denied the allegation and stated that there's no staff ever threatened clients or being mean to clients, only clients were being mean to them. Based on interviews and observations, although the allegation may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Allegation#6 "Staff disclose clients personal information" LPA interviewed 17 clients and all clients denied the allegation and reported staff never disclosed their personal information. LPA interviewed staff and all denied the allegation and reported they would never did it, its HIPPA law and violate the clients' right. Based on interviews, ahough the allegation may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Allegation#7 "Staff mishandles clients medications while in care " LPA interviewed 17 clients and 15 out of 17 clients denied the allegation and reported staff never mishandled their medication. The staff always gave them medication on time and staff always on top of their medication by refilling with the pharmacy or calling the doctor. LPA also interviewed staff and all denied the allegation and reported staff are always on top of clients medication and staff also reported they had been handled clients' medication for many years and they know how to do it. For refilling clients' medication, staff reported that they usually call before the medication has one week left. LPA also reviewed five (5) clients medication and they are seemed accurate and updated. Based on interviews and observations, although the allegation may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Based on the interviews and the investigation, it appears that there was not sufficient evidence to support the allegation, although the allegations may have happened or are valid, there are not a preponderance of evidence to prove the alleged violations did or did not occur, therefore all the allegations are UNSUBSTANTIATED.

Exit interview conducted, a copy of the report and appeal right was provided to the assistant administrator Andrew DeVera.
NAME OF LICENSING PROGRAM MANAGER: Christine Yee
NAME OF LICENSING PROGRAM ANALYST: Christine Wong
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/21/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 6
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
08/02/2021 and conducted by Evaluator Christine Wong
COMPLAINT CONTROL NUMBER: 28-AS-20210802085941

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: 166DATE:
06/21/2022
UNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Andrew DeVera TIME COMPLETED:
02:50 PM
ALLEGATION(S):
1
2
3
4
5
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9
Staff do not keep the facility free from pests
INVESTIGATION FINDINGS:
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7
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13
Licensing Program Analyst (LPA) Christine Wong conducted a subsequent complaint visit to address the above allgation and LPA met with Assistant Administrator Andrew DeVera and explained the reason of the visit and assisted LPA with the complaint visit too.

The investigation consisted of the following: On 8/3/21, LPA Spencer conducted the inital 10 days complaint visit and obtained a copy of the staff and client rosters, conducted a tour of the physical plant and interviewed the administrator and clients #1-7 (C1-C7). On today's visit, LPA Wong also interview additional 10 clients (C8-C17) and 8 staff (S1-S8) and reviewed clients' medication and toured the laundry room and kitchen and the trash can back in the parking lot.

The investigation reveled of the following: Allgation "Staff do not keep the faciltiy free from pests." LPA interviewed 17 clients and 9 out of 17 reported the faciltiy has bed bugs and roaches in their rooms.
(See LIC 9099C for continuation)
Substantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Christine Yee
NAME OF LICENSING PROGRAM ANALYST: Christine Wong
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/21/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 6
Control Number 28-AS-20210802085941
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: 06/21/2022
NARRATIVE
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The clients also reported that they saw roaches in the bathroom all the time too. LPA interviewed staff and staff also reported that the facility has bed bugs and its an ongoing issues. Even its sprayed and the pest control company came and the other day and they would see it again.

Based on LPA observations, interviews conducted and record review, the preponderance of evidence standard has been met, therefore, the above allegation is found to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division 6 and Chapter 1), is being cited on the attached LIC 9099D.

An exit interview was conducted. A copy of the report and appeal right was provided to Assistant Administrator Andrew DeVera.
NAME OF LICENSING PROGRAM MANAGER: Christine Yee
NAME OF LICENSING PROGRAM ANALYST: Christine Wong
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/21/2022
LIC9099 (FAS) - (06/04)
Page: 5 of 6
Control Number 28-AS-20210802085941
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/21/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/05/2022
Section Cited
CCR
80087(a)(1)
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80087 Buildings and Grounds (a) The facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors.
(1) The licensee shall take measures to keep the facility free of flies and other insects.
The requirement was not met as evidenced
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The Administrator shall develop a plan with the pest control company to eradicate the bed bugs in the facility. The plan of correction is due by 7/5/22
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by LPA's interviews with staff and clients and reported that faciltiy has bed bugs and its on going issues and even facility staff sprayed it and pest control company came and still saw it the other day which posed a potential risk to clients in care
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
NAME OF LICENSING PROGRAM MANAGER: Christine Yee
NAME OF LICENSING PROGRAM ANALYST: Christine Wong
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/21/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/21/2022
LIC9099 (FAS) - (06/04)
Page: 6 of 6