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

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198600539
Report Date: 08/26/2022
Date Signed: 08/26/2022 04:01:22 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
08/22/2022 and conducted by Evaluator Jose Villalobos
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20220822130713
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: 166DATE:
08/26/2022
UNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Supervisor Andrew De VeraTIME COMPLETED:
02:45 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff spoke inappropriately to client in care
Staff do not provide comfortable accommodations to resident in care
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Jose Villalobos made an unannounced initial complaint visit in response to the above mentioned allegation(s). LPA Villalobos met with Supervisor Andrew Devera and explained the purpose of the visit.

During today's visit, LPA toured the physical plant and rooms #'s 29, 35, 46, 47, 58, 113, 114, and 219. LPA interviewed Staff #1-6 (S1-S6) and clients #1-14 (C1-C14). LPA reviewed and collected copies of documents from C1's file.

The investigation revealed the following: In regards to the allegation "Staff spoke inappropriately to client in care", it was alleged that S1 and S2 make inappropriate comments to C1 to mess with C1. (6) of (6) Staff interviewed denied the allegations. (13) of (14) Clients interviewed could not corroborate the allegation. Interviews do not show that there have been any witnesses to staff speaking inappropriately to any clients.

Continued on 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: 08/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2022
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-20220822130713
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: 08/26/2022
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
LPA was not provided proof the alleged incidents occurred. Based on interviews conducted, 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 "Staff do not provide comfortable accommodations to resident in care", it was alleged that the intercom system of the facility is too loud and C1's headphone's to cancel the noise no longer work. (6) of (6) Staff interviewed denied the allegations. (13) of (14) Clients interviewed could not corroborate the allegation. Interviews show that the majority of clients in the facility do not have an issue with the volume of the intercom system. C1 purchased headphones on their own to play music so they would not hear the intercom system. LPA observed C1's headphones to be operational and C1 stated that they work fine and has multiple headphones to wear. LPA reviewed C1's file and did not observe that part of C1's needs and services was to provide headphones or noise cancelling devices. Based on interviews conducted and files 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

An exit interview was conducted with Andrew Devera and a copy of the report was provided.
NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Jose Villalobos
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2