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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198600539
Report Date: 08/17/2022
Date Signed: 08/17/2022 03:58:47 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
03/10/2021 and conducted by Evaluator Valeria Maldonado
COMPLAINT CONTROL NUMBER: 28-AS-20210310083444
FACILITY NAME:PICO RIVERA GARDENSFACILITY NUMBER:
198600539
ADMINISTRATOR:DOMINGUEZ, SANTOSFACILITY TYPE:
735
ADDRESS:6525 ROSEMEAD BLVD.TELEPHONE:
(562) 949-8489
CITY:PICO RIVERASTATE: CAZIP CODE:
90660
CAPACITY:185CENSUS: DATE:
08/17/2022
UNANNOUNCEDTIME BEGAN:
01:44 PM
MET WITH:Yitzi Teichman- AdministratorTIME COMPLETED:
04:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff are not treating resident with dignity and respect.
INVESTIGATION FINDINGS:
1
2
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4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) V. Maldonado made a subsequent complaint visit at the facility regarding the above-mentioned allegation. LPA Maldonado met with administrator Yitzi Teichman and assistant adminstrator Andrew De-Devera and explained the purpose of the visit.

On 03/17/21, LPA Kruz Long made an initial virtual complaint visit. During the visit, LPA Long interviewed Staff #1 and requested a copy of the Staff/Client Roster.

During today's visit, LPA Maldonado requested a copy of the client and staff roster, and the following documents for Clients# 1-7 (C1-C7): Facesheet, Physician's Report, and Appraisal. LPA Maldonado also conducted interviews with Staff# 1-4 (S1-S4) and C1-C7.


Report Continued on LIC9099-C...
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Valeria Maldonado
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2022
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-20210310083444
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: 08/17/2022
NARRATIVE
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Allegation: Staff are not treating resident with dignity and respect.
During confidential interviews conducted with C1-C7, (2) of (7) clients stated they do not feel like they are treated with dignity and respect. C1 states staff do not help or care about C1 because staff turn up the volume in the facility speakers and speak too loud and too fast, making the sound hurt C1's ears and brain hurt, even after C1 has told staff to lower the volume. C5 states sometimes staff speak in a way that seems belittling to C5 and other clients. C5 also states that C5 feels staff are not trained as to assist clients of "our type of mental challenges" in the facility and do not always take clients serious, regarding their claims. During confidential interviews with S1-S4, (4) of (4) staff state that clients are always treated with dignity and respect. S1-S4 state that C1 is a client who always alleges to the staff directly that they are not treating C1 with "dignity and respect." Per S1-S4, all clients are assisted on a daily basis with all of their needs and do their best to accommodate residents.

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

No deficiencies were cited during today's visit.

An exit interview was conducted with assistant administrator Andrew De-Vera and a copy of this report was provided.
NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Valeria Maldonado
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2022
LIC9099 (FAS) - (06/04)
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