191500609-1-25-2023-28-AS-RORN-CNNRV6-20230202122100

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 191500609
Report Date: 01/25/2023
Date Signed: 01/25/2023 02:51:18 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
08/09/2022 and conducted by Evaluator Luis Mora

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20220809084103

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: 152	DATE:	01/25/2023
		UNANNOUNCED	TIME BEGAN:	09:24 AM
MET WITH:	Priscilla Gaytan – Assistant Administrator		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Staff interfere with resident's visiting
Staff do not distribute a resident's medication as prescribed
Staff do not answer resident's call button in a timely manner
Staff speak to resident in an inappropriate manner
Staff do not meet resident's dietary needs
Staff do not communicate with resident's responsible party
Staff did not ensure that facility temperature is maintained comfortable for residents
Staff failed to follow the bath schedule

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Luis Mora conducted an unannounced complaint visit to determine the validity of the above-mentioned allegations. LPA met with Priscilla Gaytan (Assistant Administrator) and explained the reason for the visit.

The investigation consisted of the following: On 08/19/2022, LPA obtained copies of resident roster, staff roster, bath schedule, and Resident 1 - Resident 6 (R1 - R6) face sheets. Interviewed the Administrator and R1 - R6. Today's visit, LPA obtained copies of resident & staff rosters, copy of updated bath schedule, interviewed Resident 7 - Resident 15 (R1 - R15) and Staff 1 - Staff 3 (S1 - S3).

The investigation revealed the following: regarding the allegation "staff interfere with resident's visiting", it is alleged that an appointment to visit residents was required, there was a visitation limit of 30 minutes, and visitors were not afforded privacy with residents.
(CONTINUED TO LIC 9099C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Wei Siew Ho	TELEPHONE: (323) 981-3969
LICENSING EVALUATOR NAME: Luis Mora	TELEPHONE: 323-981-3964
LICENSING EVALUATOR SIGNATURE:	DATE: 01/25/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/25/2023

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-20220809084103

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: 01/25/2023

NARRATIVE

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Staff interviewed revealed that they used to required appointments to visit to limit the amount of visitors at the facility and to know when to expect the visitors so that they can Covid-19 screen them. They recommended a 30 minute limit to be able to allow more visitors to come and also to limit the amount of people at the facility, but this limit was never enforced. Most of the visits occurred in the residents' rooms. Staff denied not giving privacy to visitors and residents. The required appointment and 30 minute limit recommendation was done for the health and safety of the residents and to prevent a possible spread of Covid-19. Residents interviewed could not corroborate with the allegation. At the time that this complaint was filed the Provider Information Notice (PIN) that was in effect regarding visitation was PIN 22-07-ASC and two of the best practices listed on this PIN is the following: Limit the number of visitors on the facility premises at any one time to avoid having large groups to congregate and encourage shorter indoor visits and longer outdoor visits.

Regarding the allegation "staff do not distribute a resident's medication as prescribed", it is alleged that staff do not distribute medication in a timely manner. Staff interviewed revealed that they do distribute medication on a scheduled time and the times are 8am, 12pm and 5pm. Some residents have special medications that need to be given as early as 6:30am or as late as 9pm. Residents interviewed could not corroborate with the allegation.

Regarding the allegation "staff do not answer resident's call button in a timely manner", it is alleged that staff do not answer residents' call button in a timely manner. Staff interviewed revealed that they do respond to the call system within 2-3 minutes and if they are requested to go to the resident's room then it takes them no longer than 10 minutes. Residents interviewed could not corroborate the allegation.

Regarding the allegation "staff speak to resident in an inappropriate manner", it is alleged that a staff pointed a finger at a resident's face and stated, "you're not going to eat breakfast." Staff interviewed denied the allegation. Residents interviewed could not corroborate with the allegation.

Regarding the allegation "staff do not meet resident's dietary needs", it is alleged that the facility does not have scheduled meal times and that residents are served meals at various times. Staff interviewed revealed that they do have scheduled meal times and are as follow: breakfast 8:00am, lunch 12:00pm, and dinner 5:00pm. Residents interviewed could not corroborate the allegation and confirmed the meal times shown above. (CONTINUED TO LIC 9099C)

SUPERVISOR'S NAME: Wei Siew Ho	TELEPHONE: (323) 981-3969
LICENSING EVALUATOR NAME: Luis Mora	TELEPHONE: 323-981-3964
LICENSING EVALUATOR SIGNATURE:	DATE: 01/25/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/25/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 28-AS-20220809084103

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: 01/25/2023

NARRATIVE

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Regarding the allegation "staff do not communicate with resident's responsible party ", it is alleged that staff do not communicate with residents' responsible parties because either they do not answer the facility phone or staff will state that they will call back but never do. Staff interviewed revealed that there is always a staff at the receptionist area to answer calls and they do call back once they obtain the answer to the responsible party question. Residents interviewed could not corroborate the allegation.

Regarding the allegation "staff did not ensure that facility temperature is maintained comfortable for residents", it is alleged that residents have their heaters ON even when it is 90 degrees Fahrenheit outside. Staff interviewed revealed that the residents have full control of the temperature in their rooms since they all have a single AC unit. When caregivers do their 2 hour check up on the residents they inquire about the temperature if they believe it is either too cold or too hot, but most of the time the residents choose to keep it at whatever temperature they have it at. Residents interviewed could not corroborate with the allegation and stated that they have full control of the AC unit in their rooms. They choose the temperature they want.

Regarding the allegation "staff failed to follow the bath schedule", it is alleged that staff do not give residents a bath at scheduled times. Staff interviewed revealed that each resident receive 2 baths a week at different days and times. On their bath schedule they list AM or PM. So if a resident has an AM shower then the shower needs to be given any time in the morning. Residents interviewed could not corroborate the allegation.

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.

Exit interview held and a copy of the report was provided

SUPERVISOR'S NAME: Wei Siew Ho	TELEPHONE: (323) 981-3969
LICENSING EVALUATOR NAME: Luis Mora	TELEPHONE: 323-981-3964
LICENSING EVALUATOR SIGNATURE:	DATE: 01/25/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/25/2023

LIC9099 (FAS) - (06/04)

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