198600539-7-1-2022-28-AS-FFIS-CGBSCF-20220714134527

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198600539
Report Date: 07/01/2022
Date Signed: 07/01/2022 03:34:15 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
10/15/2020 and conducted by Evaluator Valeria Maldonado

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20201015112307

FACILITY NAME:	PICO RIVERA GARDENS		FACILITY NUMBER:	198600539
ADMINISTRATOR:	DOMINGUEZ, SANTOS		FACILITY TYPE:	735
ADDRESS:	6525 ROSEMEAD BLVD.		TELEPHONE:	(562) 949-8489
CITY:	PICO RIVERA	STATE: CA	ZIP CODE:	90660
CAPACITY:	185	CENSUS: 180	DATE:	07/01/2022
		UNANNOUNCED	TIME BEGAN:	03:24 PM
MET WITH:	Fabiola Padilla- Med Tech		TIME COMPLETED:	03:40 PM

ALLEGATION(S):

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Staff withheld residents cash resources.
Staff are forcing resident to go to the doctors.
Staff are not making sure resident has been properly diagnosed.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Valeria Maldonado conducted a subsequent unnanounced complaint visit to deliver findings, regarding the above mentioned allegations. LPA Maldonado met with med tech Fabiola Padilla to provide the report.

On 10/20/2020, LPA Kruz Long conducted an initial 10-day complaint visit via telephone with assistant administrator Bertha Torres. LPA Long interviewed Staff #1 and requested a copy of the Staff/Client Roster and Client #1's (C1) records.

On 06/30/2022, LPA Maldonado made a subsequent unnanouced visit to the facility. During the visit, LPA Maldonado met with assistant adminstrator Andrew Devera and toured the facility. LPA requested a copy of staff/client roster, and the following for C1: facesheet, physician's report, appraisal, and MARs for September- October 2020. LPA also interviewed Clients #1-10 (C1-C10), and staff #2-5 (S2-25).
(Report continued on LIC9099-C...)0

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Valeria Maldonado
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 07/01/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/01/2022

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-20201015112307

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: 07/01/2022

NARRATIVE

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On 07/01/2022, LPA Maldonado contacted the facility and requested C1's Record of Client's Safeguarded Cash Resources for the month of October 2020.

Allegation: Staff withheld residents cash resources- During interviews conducted with C1-C10, the investigation revealed that (9) out of (10) clients stated staff have never withheld their cash resources. C2-C10 said they always receive their personal and incidental funds (P&I) on time. Their P&I is distributed weekly, from S3 or the administrator. When they receive their P&I, they sign their name on a log and they are handed their money in cash (weekly amounts). C1-C10 also indicated that staff have never refused, and staff did not withhold giving clients their money. Clients stated that if they run out of money too soon, staff will explain to them why they won't be receiving money for that week. A review of C1's Record of Client's Safeguard Cash Resources confirms that C1 received all P&I funds for October 2020. During interviews conducted with S1-S5, the investigation revealed that S3 and the administrator are responsible for logging and distributing client's P&I. S3 explained that clients come to the office weekly and are instructed to sign and date the log, confirming that they have received their money for the week. S3 and the administrator keep records of clients who have money available and if there is ever a time when a client runs out of money too soon, they are given explanation as to why they cannot give them more money. S3 stated the majority of the residents get their P&I on a weekly basis, but C1 receives P&I in a lump sum at the beginning of the month because it was the client's decision to obtain it this way. The investigation also revealed that (5) out of (5) staff have no knowledge of other staff withholding client's P&I, no knowledge of staff refusing client's their P&I, and clients always receiving their money timely.

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED.

(Report continued on LIC9099-C...)

NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Valeria Maldonado
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 07/01/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/01/2022

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20201015112307

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: 07/01/2022

NARRATIVE

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Allegation: Staff are forcing resident to go to the doctors- During interviews conducted with C1-10, the investigation revealed that (9) out of (10) clients stated that staff have never forced them to go to the doctor. C2-C10 stated that a doctor comes to the facility once a week and are regularly seen. Clients have never witnessed staff forcing anyone to see the doctor or go to an appointment, and staff always explain to them the importance of seeing the doctor. C2-C10 also explained that if they do not feel well, staff will coordinate transportation to get them to the hospital or to a medical appointment if needed. They explained that staff are always helpful and nice to them. During interviews conducted with S1-S5, the investigation revealed that C1 refuses to see the doctor or go to doctor appointments most of the time. (5) out of (5) staff stated they have never forced any client to go to an appointment or see the doctor but encourage clients by explaining to them risks and benefits of going to their appointments and seeing the doctor. S1-S5 also stated that they would never force a client to see a doctor because clients have the right to refuse medical attention.

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED.

Allegation: Staff are not making sure resident has been properly diagnosed- During the interview conducted with C1, it was stated that staff told C1 that C1 was diagnosed with a medical condition. C1 alleges that C1 went to the hospital and claims the doctor at the hospital told C1 they were not diagnosed with said medical condition. After review of C1's physician's report and client appraisal that were provided, it is confirmed that C1 was diagnosed with said medical condition and takes medication to control it. C1 also stated that staff wanted to take C1 to see a foot doctor when C1 did not need it. The reports confirmed that that C1 had a history of surgery on the right leg. Interviews conducted with S1-S5 revealed that C1 is medication compliant, but C1 refuses to go to doctor appointments. The investigation revealed that staff are making sure clients, including C1, are being seen by a doctor to obtain medical treatment and diagnoses.

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED.

An exit interview was conducted with Fabiola Padilla. A copy of this report and the licensee appeal rights were provided.

NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Valeria Maldonado
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 07/01/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/01/2022

LIC9099 (FAS) - (06/04)

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