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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198600539
Report Date: 10/11/2022
Date Signed: 10/11/2022 03:57:01 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
10/06/2022 and conducted by Evaluator Jose Villalobos
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20221006095431
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: 160DATE:
10/11/2022
UNANNOUNCEDTIME BEGAN:
09:25 AM
MET WITH:Administrator Yitzi TeichmanTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Staff do not assist resident in obtaining medication prescriptions
Staff do not arrange transportation services for residents
Staff do not notify resident of doctor's appointments
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Jose Villalobos made an unannounced initial complaint visit in response to the above mentioned allegation(s). LPA Villalobos met with Administrator Yitzi Teichman and explained the purpose of the visit.

During today's visit, LPA interviewed Staff #1-6 (S1-S6) and clients #1-16 (C1-C16). LPA reviewed and collected copies of documents from C1's file, staff and client roster. The investigation revealed the following:

In regards to the allegation "Staff do not assist resident in obtaining medication prescriptions", it was alleged that the facility does not help C1 get the medications C1 wants. (6) of (6) Staff interviewed denied the allegations. (15) of (16) Clients interviewed could not corroborate the allegation. Interviews show that the facility staff do not create the medical prescriptions for the clients. Clients must see their doctor and doctor will prescribe the medication they see fit for each individual....

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: 10/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2022
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-20221006095431
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: 10/11/2022
NARRATIVE
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Prescriptions are given to a pharmacy who the facility will contact and receive prescribed medication from. Interviews show that staff are able to inform a clients doctors if certain medications are having side effects on clients, but it is still up to a doctor to decide what medication should be taken. 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 arrange transportation services for residents", it was alleged that the facility does not help clients with transportation to appointments. (6) of (6) Staff interviewed denied the allegations. (15) of (16) Clients interviewed could not corroborate the allegation. LPA was not given a specific example. Interviews show that the facility will provide or arrange transportation for any client when it is needed. Interviews with staff and clients stated that when appointments are made that take place out in the community, S1 notes it on the calendar book and will provide transportation for the clients. LPA reviewed the calendar book and observed appointments scheduled for clients outside in the community. Based on interviews conducted and file review, 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 notify resident of doctor's appointments", it was alleged that C1 missed a doctor appointment because the facility notified C1 that the facility doctor would be arriving 10/6/22 when in fact the doctor arrived on 10/5/22. (6) of (6) Staff interviewed denied the allegations. (15) of (16) Clients interviewed could not corroborate the allegation. Interviews show that the facility has a doctor come to the facility every two weeks. Clients are informed days prior to the doctors visit via announcements in person and on the intercom system. If a client is not able to make it to see the doctor, a client can wait another two weeks for the next visit or speak with staff about scheduling a visit out in the community. Interviews with (15) of (16) clients stated that the doctor arrived in the facility on 10/5/22 and that the facility would remind clients via the intercom system. Interviews also show that this has been the procedure in place for 5+ years. 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.

Exit interview 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: 10/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2