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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198600539
Report Date: 08/16/2022
Date Signed: 08/16/2022 01:37:40 PM

Substantiated


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
08/10/2022 and conducted by Evaluator Christine Wong
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20220810083621
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: 145DATE:
08/16/2022
UNANNOUNCEDTIME BEGAN:
08:25 AM
MET WITH:Andrew DeVera-Assistant Adminsitrator TIME COMPLETED:
02:15 PM
ALLEGATION(S):
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Facility air conditioner is in disrepair
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Christine Wong conducted a complaint investigation on the allegation listed above. LPA arrived unannounced and met with Assistant Administrator, Andrew De Vera. The purpose of the visit was explained.

The investigation consisted of the following: LPA interviewed 15 clients, seven staff and toured the room#46, #53, #102, #110, #220 and also reviewed the facility theramostat.

The investigation revealed of the following: Allegation " Facility air conditioner is in disreapir." LPA interviewed 15 clients and 11 out of 15 clients reported the air condiioner in their rooms were not working. There was no air came out from the vent. The room was hot like oven.

(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: 08/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2022
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 3
Control Number 28-AS-20220810083621
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: 08/16/2022
NARRATIVE
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LPA interviewed staff and reported there was a power outage in the past weekend but most of the rooms were back on with air conditioning in the past few days. Staff also admitted that some of the rooms in the facility are still waiting for the air conditioning company to come and fix the issues. LPA checked all the thermostat in the facility and they are able to maintain the temperature in the rooms are between 68 degrees F and 85 degrees F. but when LPA toured the room#46, #102, #110, #220 and the room that LPA stay in for interviewing, there was no air came out from the vent. It seemed heated, warmed and the humidity inside those rooms.

Based on interviews conducted and observations, the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be SUBSTANTIATED. Deficiency is cited. See LIC 9099D.

Exit interview was conducted with Assistant Administrator Andrew DeVera A copy of the report and appeal rights were provided.
NAME OF LICENSING PROGRAM MANAGER: Christine Yee
NAME OF LICENSING PROGRAM ANALYST: Christine Wong
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 28-AS-20220810083621
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: 08/16/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/30/2022
Section Cited
CCR
80087(a)
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80087(a) Buildings and Grounds
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.
This requirement was not met evidenced by:
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The administrator will ensure the faciltiy shally be in good repair at all times. The adminsitrator will fix the air conditioner for the room#46, #102, #110, #220 and also send the air conditon company receipt to LPA by POC due date.
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Based on LPA's interviews and observation, LPA toured the room#46, #102, #110, #220 and the room that LPA stay in for interview, it seemed heated, warmed and humidity and 11 our of 15 clients interviews reported their air conditioner in their rooms are not working. which poses potenial health and safety risk to persons 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: 08/16/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 3