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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198600539
Report Date: 09/28/2022
Date Signed: 09/28/2022 03:33:59 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
09/19/2022 and conducted by Evaluator Bonnie Tao
COMPLAINT CONTROL NUMBER: 28-AS-20220919104307
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: 106DATE:
09/28/2022
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Meir Yiti Teichman, AdministratorTIME COMPLETED:
03:45 PM
ALLEGATION(S):
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Facility is in disrepair.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Tao conducted an unannounced initial complaint investigation for the allegation listed above. During today’s visit, LPA Tao met Administrator, Meir Yiti Teichman and explained the purpose of today's visit.

The investigation consisted of the following: interviews with Staff #1 through Staff #2; interviews with client #1, #4 and #5; review of client #1’s facility records and a tour of the physical plant. LPA obtained copies of the Staff and client Rosters; and client #1 file for review of relevant information.

In regard to allegation of facility is in disrepair, it is alleged that client#1's room ceiling had water dripping. The investigation revealed that client#1 interviewed and stated client#1's room had water dripping from the ceiling. Two (2) out of five (5) clients could not corroborate the allegation. Two (2) out of five (5) clients were attempted to interview but unable to reach. Client interviews revealed that water dripping from client#1's room ceiling (1st floor) was due to the water overflew from the client's bathtub on the 2nd floor. Water dripping from C#1's ceiling was not from plumbing issue. (-continued in LIC 9099 C-)
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Bonnie Tao
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2022
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-20220919104307
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: 09/28/2022
NARRATIVE
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All staff denied the allegation. Staff interviews revealed C#1's room ceiling's dripping water was the water from the client on the 2nd floor. That client on the 2nd floor had a habit of overflowing bathtub water during shower. Staff had responded to C#1's dripping water issue by re-sealing the C1's ceiling and client's bathtub on the 2nd floor. File reviews revealed facility had taken immediate action to respond to the issue. LPA toured the facility and did not observe water dripping from clients' bedrooms during the visit.

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 are being cited according to California Code of Regulations, Title 22, Division 6, Chapter 8.

An exit interview was conducted with Meir Yiti Teichman, Administrator. A hard copy of this report was provided.
NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Bonnie Tao
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2