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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198600539
Report Date: 07/18/2023
Date Signed: 07/18/2023 01:54:47 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
07/17/2023 and conducted by Evaluator Jewel Baptiste
COMPLAINT CONTROL NUMBER: 28-AS-20230717113356

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: 140DATE:
07/18/2023
UNANNOUNCEDTIME BEGAN:
08:50 AM
MET WITH:Administrator Andrew Devra TIME COMPLETED:
02:10 PM
ALLEGATION(S):
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Staff make inapprorpiate comments towards residents
Staff are not ensuring residents have council meetings
INVESTIGATION FINDINGS:
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On 7/18/2023 at 8:50 a.m., Licensing Program Analyst (LPA) Jewel Baptiste conducted an unannounced complaint investigation visit for the allegations above. LPA met with Staff Julia Elias and the purpose of the visit was discussed. Administrator Andrew Devra joined the visit at 9:17 a.m.

The investigation consisted of: LPA Baptiste interviewed the Administrator and Staff #1-#3 (S1-S3) and clients #3-#13 (C3-C13). C1 was not available for interview. LPA collected copies of Dewey pest control bill dated 7/1/2023, Staff roster, Client Roster and took photos of bed bugs in room #7. LPA reviewed C1 and C2's file and collected copies of their admission agreement, needs and services plan, Identification and Emergency Information, Preplacement appraisal information, Appraisal needs and services plan, and medications list. LPA additionally conducted a tour of the physical plant.
Report Continued on 9099c
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Jewel Baptiste
LICENSING EVALUATOR SIGNATURE:

DATE: 07/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 6
Control Number 28-AS-20230717113356
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: 07/18/2023
NARRATIVE
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Regarding the allegation " Staff make inappropriate comments towards residents " it was alleged that S1 and S2 has an attitude and threaten residents. The administrator denied the allegation stating that it is usually clients disrespecting staff. 3 out of 3 staff denied the allegation stating the clients are like family to staff. 10 out of 11 clients denied the allegation. 1 out of 11 clients stated all staff are rude and disrespectful.

Regarding the allegation " Staff are not ensuring residents have council meetings " it was alleged that the facility has not had a resident council meeting in 3 years. The administrator denied the allegation stating the clients has monthly resident council meetings. The administrator further stated they provide the resident council with the resources to conduct their meetings. 3 out of 3 staff denied the allegation stating the facility conducts monthly meetings. 11 out of 11 clients denied the allegation stating they are aware of the resident council meetings because the facility announces it, and the meetings are held monthly.

Based on LPA's interviews, investigation revealed: 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 conducted with Andrew Devra and a copy of this record provided.
SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Jewel Baptiste
LICENSING EVALUATOR SIGNATURE:

DATE: 07/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 6