198600539-6-22-2022-28-AS-RORN-CHTTTM-20220831150057

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198600539
Report Date: 06/22/2022
Date Signed: 06/22/2022 05:05:16 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
06/16/2022 and conducted by Evaluator Jose Villalobos

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20220616164131

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: 166	DATE:	06/22/2022
		UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Supervisor Andrew Devera		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Facility staff do not provide sanitary drinking cups
Facility staff are disrespectful to clients
Facility staff verbally threaten clients
Staff sprayed unknown substance on clients face

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jose Villalobos conducted an unannounced complaint investigation at the facility. Upon arrival, LPA met with Supervisor Andrew Devera and explained the purpose of the visit.

The following was conducted on todays visit, LPA interviewed Staff #1-#8 (S1-S8) and Clients #1-#13 (C1-C13). LPA toured the physical plant. LPA collected documents from C1's file as well as a client and staff roster.

The investigation revealed the following: Regarding the allegation "Facility staff do not provide sanitary drinking cups" it was alleged that staff reuse water cups when clients take their medications and will also give dirty water to them. (8) of (8) staff interviewed denied the allegation. (12) of (13) clients interviewed could not corroborate the allegations. Interviews show that each client gets their own water cup when they pick up their meds...
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: 06/22/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/22/2022

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-20220616164131

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: 06/22/2022

NARRATIVE

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If a client does not finish or use their water cup, it is thrown away and not given to someone else. LPA observed that med tech staff prepare a cup of water for each client and none were reused or had dirty water. 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.

Regarding the allegation "Facility staff are disrespectful to clients" it was alleged that S1 stuck their tongue out at C1 and staff is disrespectful to clients in care. (8) of (8) staff interviewed denied the allegation. (12) of (13) clients interviewed could not corroborate the allegations. LPA was not provided with proof that S1 stuck their tongue out at C1. Interviews did not show that staff are disrespectful to the clients in care. LPA did not observe any staff being disrespectful to clients. 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.

Regarding the allegation "Facility staff verbally threaten clients" it was alleged that staff have verbally threatened C1. (8) of (8) staff interviewed denied the allegation. (12) of (13) clients interviewed could not corroborate the allegation. The only example provided to LPA was investigated and unsubstantiated in complaint #28-AS-20220509162725. LPA was not provided with different or new examples of C1 being threatened by staff. C1 did not want to provide other details. Based on the interviews, observations, and file review 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.

Continued on LIC 9099-C

NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Jose Villalobos
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 06/22/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/22/2022

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20220616164131

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: 06/22/2022

NARRATIVE

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Regarding the allegation "Staff sprayed unknown substance on clients face" it was alleged that S2 sprayed an unknown spray into C1s eyes purposely when they were in the facility elevator. (8) of (8) staff interviewed denied the allegation. (12) of (13) clients interviewed could not corroborate the allegations. Interviews show that S2 carries a disinfectant spray and uses it to disinfectant commonly touched surfaces. On the day of the alleged incident S2 was entering the empty elevator when S2 sprayed the sanitizer inside. C1 was standing outside in the hallway 4-6 ft away from the elevator entrance when S2 used their spray and C1 began to shout at S2 and accuse them of spraying into C1's face. Interviews with C2 and C3 stated that they were present during the incident and C1 was never close enough to S2 to be sprayed. Clients did not observe S2 spraying anything intentionally into C1's face. 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 with Andrew Devera 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: 06/22/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/22/2022

LIC9099 (FAS) - (06/04)

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