191500609-8-17-2023-28-AS-LHIS-CUXR3S-20230822124024

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 191500609
Report Date: 08/17/2023
Date Signed: 08/17/2023 12:23:30 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
12/23/2021 and conducted by Evaluator Alberto Lopez

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20211223152028

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: 142	DATE:	08/17/2023
		UNANNOUNCED	TIME BEGAN:	10:17 AM
MET WITH:	Priscilla Gaytan and Allison Spradley		TIME COMPLETED:	12:39 PM

ALLEGATION(S):

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Facility failed to provide a proper notice of increase in rates
Facility raised monthly rent for an SSI resident

INVESTIGATION FINDINGS:

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LPA Lopez made subsequent visit to investigate the above allegations. LPA met with Administrator Priscilla Gayton and Allison Spradley and explained the purpose of the visit.

The investigation consisted of the following: interviews with five staff members (S1-S5) and fourteen residents (R1-R14) and LPA reviewed and obtained resident roster, staff roster and copies of letters notifying SSI residents of rate increases.

The investigation revealed:
Regarding Allegation: Facility failed to provide a proper notice of increase in rates. It is alleged that facility failed to provide proper notice to SSI recipients of rate increase.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Alberto Lopez	TELEPHONE: 323-980-4926
LICENSING EVALUATOR SIGNATURE:	DATE: 08/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2023

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-20211223152028

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: 08/17/2023

NARRATIVE

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According to staff interviewed (S1-S5) all stated that the facility provides notice to all SSI recipients informing residents and/or their responsible party of any rates increases. In addition to that, the Assisted Living Waiver Program also provides them with notices of rate increases. Fourteen of fourteen residents interviewed stated that they are give proper notice or their responsible party is given notice of rate increases. LPA obtained ten copies of rate increase notices that were provided to SSI recipients regarding rate increases.

Regarding Allegation: Facility raised monthly rent for an SSI resident. It is alleged that facility is raising the rent for SSI recipients. Administrator stated that the rate increases for SSI recipients is controlled by the Assisted Living Waiver Program and not by the facility. Five of five staff denied that it is the facility that is raising the rates for SSI recipients. Fourteen of fourteen residents could not collaborate the allegation. Some residents stated they are aware of automatic rate increases every year due to COLA increases but acknowledged that it was not the facility who is raising their rates.

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 allegations are UNSUBSTANTIATED.

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Alberto Lopez	TELEPHONE: 323-980-4926
LICENSING EVALUATOR SIGNATURE:	DATE: 08/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2023

LIC9099 (FAS) - (06/04)

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