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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198600539
Report Date: 08/18/2022
Date Signed: 08/18/2022 03:40:04 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
02/19/2021 and conducted by Evaluator Jose Villalobos
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20210219145818
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: 160DATE:
08/18/2022
UNANNOUNCEDTIME BEGAN:
10:51 AM
MET WITH:Administrator Yitzi Teichman TIME COMPLETED:
02:30 PM
ALLEGATION(S):
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Residents are selling drugs in the facility
Facility staff speak inappropriately to residents
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Jose Villalobos conducted a subsequent visit for the allegations listed above. LPA met with Administrator Yitzi Teichman and the purpose of the visit was discussed.

Initial visit on 2/22/21 by LPA Tao and consisted of: a virtual Health and Safety Check, collecting of staff and client rosters, Interview with Staff#1 (S1)

On Todays visit, LPA Villalobos interviewed clients #2-#13 (C2-C13) and Staff #1-#5 (S1-S5). LPA toured the physical plant of the facility. LPA was unable to interview Client #1 (C1) as they are no longer in the facility and unable to be contacted.

The investigation revealed the following: In regards to the allegation, "Residents are selling drugs in the facility" it was alleged that on 12/11/21 S2 stated to C1 that S2 buys drugs from clients of the facility. (5) of (5) Staff interviewed denied the allegation...

Continued 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: 08/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/18/2022
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-20210219145818
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: 08/18/2022
NARRATIVE
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(12) of (12) clients interviewed could not corroborate the allegation. LPA was not provided with information as to which clients S2 was buying drugs from. LPA did not observe drugs in the facility during the physical plant tour. Review of facility files did not show there are clients who sell drugs in the facility. Based on LPA's interviews conducted, Observations and records reviewed; 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.

In regards to the allegation, "Facility staff speak inappropriately to residents" it was alleged that on 2/18/21 S2 entered the hallways where C1 was located and began to speak inappropriately to C1. (5) of (5) Staff interviewed denied the allegation. (12) of (12) clients interviewed could not corroborate the allegation. S2 denied that the incident ever occurred and would not make sense. There were no witnesses to the incident and no client interviewed showed that the incident occurred. Clients interviewed did not show that S2 speaks inappropriately to clients in care. Based on LPA's interviews conducted and observations; 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.

No Deficiencies cited under California Code of Regulations Title 22. An exit Interview was conducted and a hardcopy was provided.
NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Jose Villalobos
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/18/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2