<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198600539
Report Date: 07/28/2022
Date Signed: 07/28/2022 03:42:24 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
07/21/2022 and conducted by Evaluator Jose Villalobos
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20220721155021
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: 162DATE:
07/28/2022
UNANNOUNCEDTIME BEGAN:
10:20 AM
MET WITH:Administrator Yitzi TeichmanTIME COMPLETED:
02:40 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff made inappropriate comment to resident.
Staff yells at resident.
Facility did not provide quality milk for resident.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Jose Villalobos conducted an unannounced complaint investigation at the facility. Upon arrival, LPA met with Administrator Yitzi Teichman and Supervisor Andrew Devera. The purpose of the visit was explained.

The following was conducted on todays visit, LPA interviewed Staff #1-#7 (S1-S7) and Clients #1-#14 (C1-C14). 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 "Staff made inappropriate comment to resident." it was alleged that S1 cursed at C1 when C1 was talking about their medication. (7) of (7) staff interviewed denied the allegation. (13) of (14) clients interviewed could not corroborate the allegation. Interviews do not show that staff curse or have cursed at C1. LPA was not informed of any witnesses...

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: 07/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2022
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 2
Control Number 28-AS-20220721155021
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: 07/28/2022
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Interviews show that C1 has cursed and yelled at staff on multiple occasions and staff do not argue back. Based on the interviews conducted, 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.

The investigation revealed the following: Regarding the allegation "Staff yells at resident." it was alleged that S2 yelled at C1. (7) of (7) staff interviewed denied the allegation. (13) of (14) clients interviewed could not corroborate the allegation. LPA was not informed of any witnesses. Interviews do not show that S1 has ever yelled at any clients of the facility. Interviews show that C1 has cursed and yelled at staff on multiple occasions and staff do not argue back. Based on the interviews conducted, 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.

The investigation revealed the following: Regarding the allegation "Facility did not provide quality milk for resident." it was alleged that C1 was served milk with black dots in it that may have been leftover food. (7) of (7) staff interviewed denied the allegation. (13) of (14) clients interviewed could not corroborate the allegation. LPA was not provided of a date when the incident may have occurred. Interviews show that clients are not served milk with trash or leftover food in them. Staff in the kitchen wear gloves and serve clients one by one so to not contaminate anyone's plates. LPA observed the food supply and the milk gallons were not expired. Based on observations and interviews conducted, 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.

Continued on LIC 9099-C
NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Jose Villalobos
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2