198600539-9-15-2022-28-AS-MVAO-CJPURY-20220928154931

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198600539
Report Date: 09/15/2022
Date Signed: 09/15/2022 03:13:29 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
12/02/2020 and conducted by Evaluator Jose Villalobos

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20201202093136

FACILITY NAME:	PICO RIVERA GARDENS		FACILITY NUMBER:	198600539
ADMINISTRATOR:	DOMINGUEZ, SANTOS		FACILITY TYPE:	735
ADDRESS:	6525 ROSEMEAD BLVD.		TELEPHONE:	(562) 949-8489
CITY:	PICO RIVERA	STATE: CA	ZIP CODE:	90660
CAPACITY:	185	CENSUS: 170	DATE:	09/15/2022
		UNANNOUNCED	TIME BEGAN:	11:20 AM
MET WITH:	Staff Andrew De Vera		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

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Staff sexually abused resident.
Staff threatened resident.
Resident is being harassed while in care.
Staff spoke to resident in an inappropriate manner.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jose Villalobos conducted a subsequent visit for the allegations listed above. Today's complaint investigation was conducted with Staff Andrew De Vera, the purpose of the visit was discussed.

Initial visit was conducted on 12/3/2020 and consisted of the following: LPA conducted a virtual tour of the facility, LPA interviewed Staff #1-#2 (S1-S2) and client #1 (C1), LPA reviewed security footage. LPA also requested the following: a copy of the Staff/Client Roster and Client #1's records.

On todays visit, LPA interviewed Staff#3-6 (S3-S6) and clients #2-#14 (C2-C14). LPA unable to interview Staff #7-#9 (S7-S9) as they no longer work in the facility and LPA was unable to contact them. The investigation revealed the following:

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: 09/15/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2022

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-20201202093136

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: 09/15/2022

NARRATIVE

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In regards to the allegation "Staff sexually abused resident" it was alleged that S3 and S7 have sexual relations with clients of the facility. (6) of (6) Staff interviewed denied the allegation. (13) of (14) Clients interviewed could not corroborate the allegation. Interviews do not show that staff have ever had sexual relations with clients in care. All clients interviewed denied the allegations or denied any knowledge of it occurring. LPA was not provided with proof or further information. 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 allegation is unsubstantiated

In regards to the allegation "Staff threatened resident" it was alleged that staff threatened C1 on 11/5/20 and again through C1's room door in the middle of the night on 11/16/20. (6) of (6) Staff interviewed denied the allegation. (13) of (14) clients interviewed could not corroborate the allegation. Interviews do not show that staff threatened C1 in the facility. LPA reviewed footage during the initial visit with the S1 from 11/16/20 between 2-3am. The footage shows a client standing in front of a fire alarm for approximately 2 minutes before pulling it. Staff arrived less than a minute later to turn off the alarm as it was a false alarm. Review of the security footage nearest C1's room does not show any staff going up to the door to shout or make threats. Based off interviews and observations; 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 allegation is unsubstantiated

In regards to the allegation "Resident is being harassed while in care" it was alleged that staff and clients of the facility have tampered with C1's phone continuously to harass C1. (6) of (6) Staff interviewed denied the allegation. (13) of (14) Clients interviewed could not corroborate the allegation. Interviews do not show that Staff or clients in care tampered with C1's phone and pretended to be other people over the line. LPA was not provided proof or further information as to who was tampering with C1's phone. Based off interviews; 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 allegation is unsubstantiated

Continued on LIC 9099-C

NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Jose Villalobos
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 09/15/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2022

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 28-AS-20201202093136

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: 09/15/2022

NARRATIVE

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In regards to the allegation "Staff spoke to resident in an inappropriate manner" it was alleged that facility staff yell and respond to C1 aggressively. (6) of (6) Staff interviewed denied the allegation. (13) of (14) Clients interviewed could not corroborate the allegation. Interviews with staff and clients show that C1 will yell and curse at the facility staff, but staff do not yell speak inappropriately to C1. LPA was not provided with proof that staff speak to clients in an inappropriate manner. Based off interviews; 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 allegation is unsubstantiated

Exit interview was conducted, and a copy of this report was provided.

NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Jose Villalobos
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 09/15/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2022

LIC9099 (FAS) - (06/04)

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