191500609-8-11-2023-28-AS-RORN-CV6V5U-20230829160832

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 191500609
Report Date: 08/11/2023
Date Signed: 08/11/2023 03:51:40 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
08/08/2022 and conducted by Evaluator Tena Herrera

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20220808143956

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:	08/11/2023
		UNANNOUNCED	TIME BEGAN:	09:31 AM
MET WITH:	Priscilla Gaytan - Administrator		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Facility carpets are in disrepair.
Staff do not assist residents timely.
Food is not of nutritious quality for residents in care.
Residents are left in soiled diapers.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Tena Herrera conducted an unannounced complaint investigation, upon arrival LPA met with Priscilla Gaytan (Administrator) and the purpose of the visit was explained.

The investigation consisted of the following: during the initial visit conducted on 8/16/22. LPA Kruz Long obtained a copy of the Staff/Resident rosters, suggestion form and the food menu, toured the facility and interviewed Staff # 1-4 (S1-S4). During todays subsequent visit LPA Herrera interviewed an additional 4 Staff and 11 Residents, obtained copies of the Staff/Residnet Rosters, Staff Scedule, Food Menu, and toured the facility.

The investigation revealed the following:
Allegation: Facility carpets are in disrepair.
It was reported that the carpets are stained in the facility. LPA toured the facility and was informed that there was previously carpets throught the facility, however, about eight months ago the facility did an upgrade and changed the flooring to laminate floors where the carpet previously was. Additionally, LPA
(Continued on 9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: David Sicairos	TELEPHONE: (323) 981-3982
LICENSING EVALUATOR NAME: Tena Herrera	TELEPHONE: 323-980-4633
LICENSING EVALUATOR SIGNATURE:	DATE: 08/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2023

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-20220808143956

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: 08/11/2023

NARRATIVE

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toured various rooms and interviewed residents regarding carpet in resident rooms, 10 out of 12 residents denied the above allegation and stated that their carpets are cleaned as needed and vacuumed daily. Those 10 residents also stated that if there is a spill in the room staff will attend to the cleaning right away or place a work order to have it cleaned within the week depending on severity of the stain and cause of stain. 8 out of 8 staff stated that carpets are cleaned as needed and vacuumed daily. Depending on stain maintenance will either shampoo the carpet same day or within 3-5 days depending on the work load.

Allegation: Staff do not assist residents timely.
It is alleged that staff do not help the resident's in a timely manner and residents are not helped up timely if they fall. 10 out of 12 residents interviewed denied the above mentioned allegation and stated that during the times that they have needed to use the call button for assistance there was a quick response, within seconds for initial response on the intercom, followed by caregiver physically checking on the resident within a minute or less. The 8 out of 8 staff interviewed stated that when the call button is pressed for assistance they are alerted immediately, depending if they are assisting another resident with a major need results in their response time, also the severity of the need is taken into consideration for a possible alternate staff to rush and assist resident. Additionally, LPA tested the call button that is used when in need of assistance in one resident room to test staff response time, once button was pushed a voice came on asking if assistance was needed LPA advised it was a test and no more than 15 seconds later a caregiver appeared to check on resident.

Allegation: Food is not of nutritious quality for residents in care.
It was reported that the food is not of nutritious quality. 11 out of 12 residents interviewed denied the allegation. The residents did however state that the taste of the food is not of their preference and not something that they would prepare themselves but as far as receiving the proper nutrition they agreed that they are given a well balanced meal with proper protein, fruits and vegetables. Additionally, LPA observed the amount of perishable and non-perishable food in the kitchen and there was sufficient meats, breads, fruits and vegetables to meet the needs of the residents. Food served during todays visit was also observed and seemed to be of proper nutrition.

Allegation: Residents are left in soiled diapers.
11 out of 12 residents interviewed denied the above allegation. Residents interviewed that require
(Continued on 9099-C)

SUPERVISOR'S NAME: David Sicairos	TELEPHONE: (323) 981-3982
LICENSING EVALUATOR NAME: Tena Herrera	TELEPHONE: 323-980-4633
LICENSING EVALUATOR SIGNATURE:	DATE: 08/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2023

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20220808143956

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: 08/11/2023

NARRATIVE

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incontinence care stated that they change themselves but feel confident that when the time comes for them to need assistance they will receive it as they are asked by staff almost daily if assistance is needed but they deny the help. It was also stated that staff regularly changes the padding on beds of the residents on incontinence care. 8 out of 8 staff interviewed confirmed that the residents are checked on every 2 hours unless they are on an hourly schedule. During these checks they assist residents with incontinence care.

Based on observation, file review, statements, and interviews conducted with staff and residents, there was not enough supportive evidence to concur with the reported allegations. 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 this report was provided to Administrator Priscilla Gaytan.

SUPERVISOR'S NAME: David Sicairos	TELEPHONE: (323) 981-3982
LICENSING EVALUATOR NAME: Tena Herrera	TELEPHONE: 323-980-4633
LICENSING EVALUATOR SIGNATURE:	DATE: 08/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2023

LIC9099 (FAS) - (06/04)

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