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

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198600539
Report Date: 08/16/2022
Date Signed: 08/16/2022 04:55:54 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
08/09/2022 and conducted by Evaluator Nune Margaryan
COMPLAINT CONTROL NUMBER: 28-AS-20220809083340
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: 146DATE:
08/16/2022
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH: Andrew De-Vera - Supervisor TIME COMPLETED:
04:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not treat client with dignity and respect
Client is being harassed while in care
Client's personal belongings are missing from client's room
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Nune Margaryan conducted a complaint inspection on the above allegations. LPA arrived unannounced and met with Andrew De-Vera - Supervisor who assist with the visit. LPA explained the purpose of the inspection.

The Investigation consisted of the following: LPA obtained a copy of the Client Roster and Staff Roster, Medication Administration Report (MAR), Review C1’s file and obtained copies of relevant documents. Interviews conducted with Supervisor, Staff #1 (S1) to Staff #5 (S5) from 11am - 1:30pm and Client #1 (C1) to Client #6 (C6) from 1:30pm - 2:30pm.

Continue 9099C
Unsubstantiated
Estimated Days of Completion: ``````
NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Nune Margaryan
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-20220809083340
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
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
Investigation revealed the following: Regarding allegations: "Staff did not treat client with dignity and respect" and "Client is being harassed while in care". It was alleged that C1 was ignored by staff. Staff gave C1 their medications after C1 repeatedly asked staff 5-6 times. Staff always make him wait whenever he asks the staff for his/her medicine. Staff give dirty looks to clients. Supervisor and staff denied that staff did not treat resident with dignity and respect and harassed clients. They stated staff never ignored C1 or other client and make C1 or other clients to wait to get their medications. Supervisor and staff stated medications are dispensed to clients at the facility office and they denied that C1 or other clients were waiting to get their medications. Interviews with staff revealed that facility staff do not ignored C1 or any other client in care and they have not witnessed any staff ignored C1 or other client when they ask for their medicine. Interviews with clients C2 - C6 revealed that facility staff are helpful and respectful and didn't give dirty looks to clients. They stated that staff are always there and take care of them. They stated that they never wait to get the medications and staff didn’t ignore them. Interviewed C1 indicated that he/she harassed by staff . Staff make him wait whenever he asks the staff for his medication.

Regarding allegation:" Resident's personal belongings are missing from C1 room". It was alleged that every night when C1 sleeps and wakes up in the morning his/her personal belongings are missing from his/her room. C1 believes that the staff are stealing his/her personal belongings. The housekeepers interviewed denied stealing clients' personal belongings. They stated they do not take or throw away any belongings of client. When they clean, they would clean around their belongings. The only things they would throw out are dirty cups and rotten food as instructed by the Supervisor in order to avoid pests. According to the interviews with clients, five (5) of them have stated their personal belongings were not stolen or missing. Interview with Supervisor revealed that clients did not report that any of their personal items are missing and are taken / stolen by staff at night when they were sleeping. Interviewed supervisor and staff stated that staff are trained to follow up regarding client's concerns regarding missing items.

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.



Exit interview conducted and a copy of this report was provided to the Supervisor


NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Nune Margaryan
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