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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198600539
Report Date: 10/31/2022
Date Signed: 10/31/2022 03:35:44 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
10/26/2022 and conducted by Evaluator Jose Villalobos
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20221026123143
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: 170DATE:
10/31/2022
UNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Assistant Administrator Andrew De Vera TIME COMPLETED:
12:45 PM
ALLEGATION(S):
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Staff speaks inappropriately to client in care
Client in care was not provided proper food service
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Jose Villalobos conducted an initial complaint visit regarding the allegations above. LPA met with Assistant Administrator Andrew De Vera and the purpose of the visit was discussed.

On todays visit LPA toured the physical plant and observed the food supply. LPA reviewed and collected copies of files from Client #1's file. LPA interviewed clients #1-#16 (C1-C16) and staff #1-#5 (S1-S5) during todays visit. The investigation revealed the following:

In regards to the allegation "Staff speaks inappropriately to client in care" it was alleged that S1 used profanity when speaking to C1. (5) of (5) Staff interviewed denied the allegation. (15) of (16) clients interviewed could not corroborate the allegation. Interviews do not show that the incident occurred. LPA was not provided with witnesses to the incident....

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: 10/31/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/31/2022
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-20221026123143
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: 10/31/2022
NARRATIVE
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Interviews with clients does not show that staff use profanity when speaking with the clients of the facility. Based on interviews and observations, 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 this allegation is unsubstantiated.

In regards to the allegations, "Client in care was not provided proper food service" it was alleged that there was a fly and spider on C1's meals on two separate occasions. (5) of (5) Staff interviewed denied the allegation. (15) of (16) Clients interviewed could not corroborate the allegation. Interviews do not show that clients have bugs on their meals. Staff interviewed did not state that clients have shown them of having bugs in their meals. LPA observed the food supply of the facility and did not observe any health and safety violations. LPA was not provided with proof that there were bugs on meals in the facility. LPA was not provided with a specific date that incident occurred. Based on interviews and observations, 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 this 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: 10/31/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/31/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2