198600539-9-7-2022-28-AS-RORN-CSZKXD-20230621081720

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198600539
Report Date: 09/07/2022
Date Signed: 09/07/2022 05:08:59 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
08/29/2022 and conducted by Evaluator Nune Margaryan

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20220829160015

FACILITY NAME:	PICO RIVERA GARDENS		FACILITY NUMBER:	198600539
ADMINISTRATOR:	MEIR SHAUL YITZI TEICHMAN		FACILITY TYPE:	735
ADDRESS:	6525 ROSEMEAD BLVD.		TELEPHONE:	(562) 949-8489
CITY:	PICO RIVERA	STATE: CA	ZIP CODE:	90660
CAPACITY:	185	CENSUS: 168	DATE:	09/07/2022
		UNANNOUNCED	TIME BEGAN:	12:45 PM
MET WITH:	Administrator Yitzi Teichman		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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Lack of supervision resulting in resident threatened while in care

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Nune Margaryan conducted an unannounced initial 10-Day complaint investigation regarding the above allegation. LPA explained the purpose of today's visit to Administrator Yitzi Teichman who assisted with this visit.

The investigation consisted of the following: LPA obtained copies of Staff & Resident Rosters, interviewed Administrator, Staff 1 to Staff 4 (S1 to S4), Client 1 to Client 6 (C1 to C6). Reviewed C1's and C2's files and obtained the copies of relevant documents.

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: 09/07/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2022

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20220829160015

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: 09/07/2022

NARRATIVE

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Investigation revealed the following: Regarding allegation, Lack of supervision resulting in client threatened while in care. It was alleged that C1 was threatened by C2. And the reason that C2 has been spreading rumors about C1 is trying to steal C2’s boyfriend. C2 told C1 that he/she will kill C1 the next time he/she sees C1. C2 came and sat on C1 when C1 had a lunch in the dining room, hurting her stomach and thighs.

Interviewed Administrator denied the allegation. Administrator stated that the facility have adequate staffing. Administrator stated that their always ensures that the facility is fully staffed to provide proper care and supervision to facility clients. Administrator stated that there is always someone in the dining room, Telecare Room and front desk as that is where clients go when they need something. Administrator stated that they are partners with Telecare Program and Resident Case Managers from that program are visiting the clients every day. Administrator stated that C1's Case Manager informed him/her that C1 reported to him/her that C1 was threatened by C2 , and incident happened in the dinning room that C2 sat on C1, hurting C1. Case Manager reported on 08/30/22 to the Administrator and stated that incident between C1 and C2 happened 2 weeks ago ( no specific date was provided). Administrator told Case Manager that he/ she will investigate the incident. Administrator spoke with C1 and C2. C1 didn't tell anything about incident. C2 told to Administrator that he/she never threatened C1 and didn't sat on C1, hurting C1's stomach or thighs. All interviewed staff denied the allegation. They stated that there are always enough staff to supervise the clients. They stated that didn't witnesses that C1 was threatened by C2. C1 didn't report to the staff or Administrator about the incident. Interviews conducted with facility staff revealed that the facility is adequately staff to provide proper care and supervision to clients. Interviewed C1 and C2 denied that C2 told C1 that he/she will kill C1 the next time he/she sees C1. C1 stated C2 sat on him/her but did not confirm that C2 did that to hurt him/her. C2 stated that he/she never sat on C1. Interviews conducted with 6 clients revealed that they believe there are enough staff at the facility. They stated that they will report to the Administrator any incident happened with them or if they witnesses any incident. Interviewed clients stated that staff are very efficient and good at taking care of arguments or fights that arise within clients. LPA reviewed facility schedule and observed that there is enough staff on schedule to properly oversee / supervise clients.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation did or did not occur, therefore the allegation is unsubstantiated.

Exit interview held. A copy of the report was provided to Assistant Administrator.

NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Nune Margaryan
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 09/07/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2022

LIC9099 (FAS) - (06/04)

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