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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198600539
Report Date: 10/06/2022
Date Signed: 10/06/2022 11:43:13 AM

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
02/05/2020 and conducted by Evaluator Angelica Rea
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20200205090818
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: 168DATE:
10/06/2022
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Julia Elias TIME COMPLETED:
12:00 PM
ALLEGATION(S):
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Resident was sexually abused while in care
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs) Angelica Rea and Kimberly Ramirez conducted another visit to deliver the final results of the investigation. LPAs met with Asssistant Administrator, Julia Elias who assisted with today's visit.

Regarding the allegation that resident #1 was sexually abused while in care. The investigation was conducted by the department and consisted of interview(s) with Administrator, Staff #1, Resident #1, Hospital Social Worker and review of Resident #1's file including medical records. Resident #1 was not present at the facility when initial visit was conducted on 2/6/2020.

The investigation revealed the following: Resident #1 lived at the facility from 9/18/19 to 6/23/21. Resident #1 was admitted to hospital on 2/20/20 for suicidal ideations, and made the allegation that she was sexually abused at the facility during the hospital stay. Facility staff stated that resident #1 did not report this allegation to staff.
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Angelica Rea
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2022
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-20200205090818
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: 10/06/2022
NARRATIVE
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Resident #1 was unable to provide detailed information regarding allegation. Resident #1's conservator indicated that resident #1 has a long history of making false allegations. Hospital social worker stated that resident #1 suffers from tactile delusions due to history of heavy alcohol and drug abuse. Resident #1 tested positive for drug use during hospital stay.

Based on LPA's observations and interviews, investigation revealed: 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 conducted and copy of report was provided to Assistant Administrator.
NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Angelica Rea
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2