198600539-8-17-2022-28-AS-RORN-CJFV74-20220920161028

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198600539
Report Date: 08/17/2022
Date Signed: 08/17/2022 02:31:36 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
08/11/2022 and conducted by Evaluator Mary G Flores

COMPLAINT CONTROL NUMBER: 28-AS-20220811100250

FACILITY NAME:	PICO RIVERA GARDENS		FACILITY NUMBER:	198600539
ADMINISTRATOR:	MEIR SHAUL YITZI TEICHMAN		FACILITY TYPE:	735
ADDRESS:	6525 ROSEMEAD BLVD.		TELEPHONE:	(562) 949-8489
CITY:	PICO RIVERA	STATE: CA	ZIP CODE:	90660
CAPACITY:	185	CENSUS: 160	DATE:	08/17/2022
		UNANNOUNCED	TIME BEGAN:	10:25 AM
MET WITH:	Yitzi Teichman - Administrator		TIME COMPLETED:	01:30 PM

ALLEGATION(S):

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Client's room is not being cleaned adequately
The facility has bed bugs

INVESTIGATION FINDINGS:

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Licensing Program Analyst(s)(LPA) Mary Flores conducted an unannounced complaint investigation visit regarding the above allegation(s). LPA Flores met with Yitzi Teichman Administrator and explained the reason for the visit.

The investigation consisted of the following: LPA Flores requested a copy of staff/client roster, conducted a tour of the facility and observed rooms #1,4,14,36,46,53,101,105,109,114,201,207,212,218, and interviewed staff #1(S1),#2(S2),#3(S3),#4(S4),#5(S5),#6(S6) and requested copies of pest control services for June, July, August 2022.On 8/15/22 LPA interviewed clients #1(C1),#2(C2),#3(C3),#4(C4),#5(C5),#6(C6)#7(C7),#8(C8),#9(C9),#10(C10),#11(C11),#12(C12),#13(C13),#14(C14),#15(C15),#16 over the phone.

The investigation revealed the following: Regarding allegation: Client's room is not being cleaned adequately. It is alleged staff should change the bedding timely when there's brown smelly "stuff" on client's bed.
(CONTINUED LIC 9099C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Stefanie Coronel	TELEPHONE: (323) 981-3961
LICENSING EVALUATOR NAME: Mary G Flores	TELEPHONE: (323) 981-3965
LICENSING EVALUATOR SIGNATURE:	DATE: 08/17/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2022

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-20220811100250

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: 08/17/2022

NARRATIVE

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Interviews with clients revealed the following 13 out of 16 clients interviewed stated housekeeping doe a deep cleaning once a week and regularly changes towel and cleans bathroom. 2 out of 16 clients interviewed stated that currently housekeeping is not cleaning timely. 1 out of 16 clients interview was unable to be interview due to cognitive skills. Interviews with staff revealed 6 out of 6 staff stated clients rooms are deep clean once a week, and housekeepers check each client bedroom daily to provide towels, toilet paper, and remove trash. Staff stated that upon observing or clients reporting feces in toilet or bed sheets staff cleans it or changes sheets right away. LPA did not observed feces in bedsheets during the facility's tour.

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.

Regarding allegation: The facility has bed bugs. It is alleged client's room has bed bugs. Interviews with clients revealed 13 out of 16 clients interviewed stated not to have seen or have bed bugs in their rooms, 2 out of the 13 stated to have heard others have bed bugs. 3 out of 16 clients interview stated to have observed a bed bug in their room recently. 1 out of 16 clients was unable to be interview due to cognitive skills. Interviews with staff revealed 4 out 6 staff stated clients or staff reported to have observed bed bugs in clients rooms. 2 out of 6 staff stated to have not observed or heard of bed bug reports. Administrator stated bed bug treatments were initiated months ago and are actively treating at the time. LPA did not observed any bed bugs during the tour of the facility. LPA Flores reviewed pest control invoices for Dewey Pest Control for 6/1/22 through 8/1/22. Dewey Pest control dated 3/8/22 has order to treat all client rooms with "gel bait, dust, or liquid residuals".

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 was conducted with Yitzi Teichman administrator and a copy of this report was provided.

SUPERVISOR'S NAME: Stefanie Coronel	TELEPHONE: (323) 981-3961
LICENSING EVALUATOR NAME: Mary G Flores	TELEPHONE: (323) 981-3965
LICENSING EVALUATOR SIGNATURE:	DATE: 08/17/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2022

LIC9099 (FAS) - (06/04)

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