191500609-9-6-2023-28-AS-RORN-CWJKVE-20231012081410

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 191500609
Report Date: 09/06/2023
Date Signed: 09/06/2023 01:25:18 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
12/22/2021 and conducted by Evaluator Alberto Lopez

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20211222090744

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: 138	DATE:	09/06/2023
		UNANNOUNCED	TIME BEGAN:	09:54 AM
MET WITH:	Priscilla Gaytan		TIME COMPLETED:	01:39 PM

ALLEGATION(S):

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Insufficient staff to meet residents needs.
Covid-19 safety protocols are not being followed.
Resident's requests for assistance are not being responded to in a timely manner

INVESTIGATION FINDINGS:

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LPA Lopez made subsequent unannonced visit to investigate the above allegations. LPA met with Administrator Priscilla Gaytan and explained the purpose of the visit. LPA made initial visit on 12/28/2021.

During the initial visit LPA toured the facility with Administrator and tested call light response time in several random rooms.
LPA obtained the resident and staff roster. Interviews were conducted with Administrator and 8 residents.

During subsequent visit, LPA interviewed four staff S#2- S#5 and six additional residents R#9- R#14 that were at facility around December 2021 LPA obtained proof that facility was utilizing staff registry to assist staff and staff schedules forn10/2021, 11/2021 and 12/2021
(Continue on (9099C)

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: 09/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2023

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-20211222090744

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: 09/06/2023

NARRATIVE

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Regarding Allegation: Insufficient staff to meet resident’s needs. It is alleged that the facility does not have enough staff to meet resident’s needs.

The investigation revealed that during the Month of 2021 when the allegations were made, Facility was experiencing covid infections and some staff had to be sent home to isolate. Facility crossed trained staff to cover for absent staff. Administrator stated that they have enough staff to care for the needs of all residents. 5 of 5 staff denied the allegations. Administrator and other staff stated that due to the pandemic, the facility reached out to staff registries help facility out when staff was sent home to isolate. LPA interviewed 14 residents and 9 of 14 residents stated that there is enough staff to meet resident’s needs. Administrator and Medication technician stated that only authorized staff dispense medication. When other staff was sent to medication room, it was just to assist with the call box.

Regarding Allegation: Covid-19 safety protocols are not being followed. It is alleged that the facility is not following Covid-19 protocols and that is contributing to Covid-19 spread. LPA interviewed fourteen residents and 12 of 14 residents could not collaborate the allegations. All staff stated that facility is adamant with staff following all covid 19 safety protocols. LPA was screened on every visit made to the facility and observed staff following covid safety protocols including wearing mask throughout the facility.

Allegation: Resident's requests for assistance are not being responded to in a timely manner. It is alleged that staff are not responding to help in timely manner. 5 of 5 staff denied the allegations. Some staff stated that all calls are prioritized according to needs. For example, Personal care will take priority over locating a remote for the TV. However, communication with all residents asking for assistance is answered promptly. LPA interviewed 14 residents and 13 of 14 residents could not collaborate the allegation. Several residents stated that their calls for assistance are answered promptly or at minimum contacted by staff to give an estimated time when they will be able to respond if it will take longer than usual. LPA randomly tested the call lights in 5 rooms and staff responded in timely manner.

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 held. A copy of the report was provided.

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Alberto Lopez	TELEPHONE: 323-980-4926
LICENSING EVALUATOR SIGNATURE:	DATE: 09/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2023

LIC9099 (FAS) - (06/04)

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