191500609-10-28-2022-28-AS-TVAO-CM3UUB-20221213145317

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 191500609
Report Date: 10/28/2022
Date Signed: 10/28/2022 03:59:25 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 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 Cynthia D Chan

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20221026132415

FACILITY NAME:	SAN DIMAS RETIREMENT CENTER		FACILITY NUMBER:	191500609
ADMINISTRATOR:	PRISCILLA GAYTAN		FACILITY TYPE:	740
ADDRESS:	834 WEST ARROW HIGHWAY		TELEPHONE:	(909) 599-8441
CITY:	SAN DIMAS	STATE: CA	ZIP CODE:	91773
CAPACITY:	343	CENSUS: 149	DATE:	10/28/2022
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Priscilla Gaytan, Assistant Administrator		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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1. Inadequate staffing to meet resident's needs.
2. Staff is not providing adequate food service to residents.
3. Staff does not have an activity schedule for residents.
4. Staff is not addressing pest infestation.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Cynthia Chan conducted a complaint investigation regarding the allegations listed above. LPA met with Assistant Administrator, Priscilla Gaytan, and explained the purpose of the visit.

LPA obtained copies of the Resident roster, Staff roster, weekly menus, activities calendar, and pest control services reports. Interviews were held with the Assistant Administrator, 8 Staff, and 10 Residents today.

The investigation revealed the following:

Allegation – Inadequate staffing to meet resident’s needs. Per the Assistant Administrator, the company works with a registry to obtain more staff when needed. They are currently utilizing the registry and actively conducting interviews to hire more staff. 7 out of the 8 staff interviewed do not feel there is a staffing shortage. They have seen registry staff filling in when someone is off.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Tony Vasallo	TELEPHONE: (323) 981-3977
LICENSING EVALUATOR NAME: Cynthia D Chan	TELEPHONE: (323) 981-3370
LICENSING EVALUATOR SIGNATURE:	DATE: 10/28/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2022

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 3

Control Number 28-AS-20221026132415

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: SAN DIMAS RETIREMENT CENTER	FACILITY NUMBER: 191500609
	VISIT DATE: 10/28/2022

NARRATIVE

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LPA interviewed 10 residents. 4 out of the 10 residents feel there is not enough staff to assist with their needs, stating that the staff do not do a good with the showers and would take them awhile to assist. The other 6 residents feel there has been improvement with the staffing and currently has sufficient number of staff to fulfill residents’ needs. LPA toured the facility and observed caregivers, housekeepers, Med Techs, and food servers assisting residents.

Allegation – Staff is not providing adequate food service to residents. It is alleged that the food is not properly cooked, always cold, no variety, and not able to get seconds. It is also alleged the facility does not give snacks or coffee. LPA toured the kitchen and observed a variety of foods in the refrigerator. The food was being prepared by the chef and the servers delivering the food trays (wrapped) to the rooms. The food served to the residents came straight from the kitchen for those eating in the dining room. LPA also observed snacks and beverages readily available in the dining room. LPA obtained a copy of the weekly menu for 4 weeks. The menu included different items from each food group and listed alternatives, including snack times on the menu. Per the Assistant Administrator, the menu is given to the residents every Sunday in their rooms. Staff interviewed acknowledged that some residents complained of the foods but they have not personally seen food not properly cooked, cold, or not given a variety. 4 out of the 10 residents expressed that the foods are served to them cold, meaning the hot items are no longer hot when it gets delivered. It was also expressed that they get the same food over again, each week. 6 residents stated the food has improved and tastes better with this new chef. The food is not served to them cold and are able to obtain more if they request it.

Allegation – Staff does not have an activity schedule for residents. During the arrival today, LPA observed some residents engaged in an exercise activity held by the Activity Director, in the room by the lobby. LPA observed the activity calendar posted on the bulletin board by the dining room. Staff interviewed indicated that there are activities held daily and encourage residents to participate. 10 of the 10 residents interviewed stated there are activities held but some stated they do not participate in them due to their preferences.

(Continue on LIC9099C)

SUPERVISOR'S NAME: Tony Vasallo	TELEPHONE: (323) 981-3977
LICENSING EVALUATOR NAME: Cynthia D Chan	TELEPHONE: (323) 981-3370
LICENSING EVALUATOR SIGNATURE:	DATE: 10/28/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2022

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 28-AS-20221026132415

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: SAN DIMAS RETIREMENT CENTER	FACILITY NUMBER: 191500609
	VISIT DATE: 10/28/2022

NARRATIVE

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Allegation – Staff is not addressing pest infestation. During the tour of the entire facility, LPA did not observe any cockroaches or other pests inside the facility or in the garden areas. LPA reviewed the Western Exterminator Company service reports from August 2022 through October 2022, and there were no pest activities found during their visits. The services are done twice a month which targets cockroaches and mosquitos. Staff interviewed stated they have not seen any more roaches lately since they have been spraying the grounds. One of the 10 residents interviewed has seen cockroaches in the hallways this morning on the 2^nd floor. Residents interviewed stated the staff will spray immediately if they see a roach or two and have seen the pest control technician come out to spray.

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED.

An exit interview was conducted with Priscilla Gaytan. A copy of this report along with the appeal rights were provided.

SUPERVISOR'S NAME: Tony Vasallo	TELEPHONE: (323) 981-3977
LICENSING EVALUATOR NAME: Cynthia D Chan	TELEPHONE: (323) 981-3370
LICENSING EVALUATOR SIGNATURE:	DATE: 10/28/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2022

LIC9099 (FAS) - (06/04)

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