191500609-1-19-2024-28-AS-LHIS-CZRMWF-20240123085814

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 191500609
Report Date: 01/19/2024
Date Signed: 01/19/2024 04:18:40 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
05/23/2022 and conducted by Evaluator Angelica Rea

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20220523124939

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: 131	DATE:	01/19/2024
		UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Priscilla Gaytan		TIME COMPLETED:	04:40 PM

ALLEGATION(S):

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Staff does not provide adequate food service.
Facility serves food of poor quality.
Facility does not have enough staff to meet residents' needs.
Residents are not receiving medication as prescribed.
Residents' hygiene needs are not being met.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Angelica Rea conducted another visit to deliver the final results of the investigation. LPA met with Administrator, Priscilla Gaytan who assisted with today's visit.

Regarding the allegation that : (1) Staff does not provide adequate food service, and the (2) facility serves food of poor quality, the investigation consisted of : interviews with Administrator and staff #1- staff #4, and resident #1 - resident #11, tour of the kitchen, review of facility food supply, and review of facility menu. Administrator and staff stated that staff do provide adequate food service. They stated that residents are served adequate portions of food, and they can request to get second servings as well. Administrator and Staff stated that the food served is of good quality. Residents interviewed were unable to corroborate the allegation(s). Eight out Eleven residents stated that the facility does provide adequate food service, and EIght out of Eleven residents stated that the food served is good quality. LPA reviewed food supply, and observed that the food appeared to be of good quality. LPA observed that the facility had a sufficient amount of perishable and non perishable food on today's visit.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Angelica Rea	TELEPHONE: (323) 980-4929
LICENSING EVALUATOR SIGNATURE:	DATE: 01/19/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/19/2024

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-20220523124939

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: SAN DIMAS RETIREMENT CENTER	FACILITY NUMBER: 191500609
	VISIT DATE: 01/19/2024

NARRATIVE

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Regarding the allegation that : (3) the facility does not have enough staff to meet residents' needs, the investigation consisted of review of staff roster, and interviews with Administrator, staff #1- staff #4, and resident #1 - resident #11. Administrator and staff interviewed, denied the allegation. They stated that the facility has sufficient staff to meet resident needs. Residents interviewed were unable to corroborate the allegation. Nine out of Eleven residents interviewed stated that the facility has enough staff to meet resident needs. Review of staff roster, indicates that the facility has sufficient staff to meet the needs of residents.

Regarding the allegation that : (4) residents are not receiving medication as prescribed. The investigation consisted of review of a portion of resident medication(s) and interviews with Administrator, staff #1- staff #4, and resident #1 - resident #11. Administrator and staff interviewed, denied the allegation. They stated that residents are receiving their medications as prescribed. Residents interviewed were unable to corroborate the allegation. Eleven out of eleven residents interviewed stated that they are receiving their medication as prescribed. Review of resident(s) medications, indicate that residents medications are being administered as prescribed.

Regarding the allegation that : (5) residents' hygiene needs are not being met. The investigation consisted of interviews with Administrator, staff #1- staff #4, and resident #1 - resident #11. Administrator and staff interviewed, denied the allegation. They stated that residents who require assistance with hygiene, receive assistance from staff. Residents interviewed were unable to corroborate the allegation. Eleven out of eleven residents interviewed stated that either they do not require assistance, or if they do, they stated that they receive assistance from staff.

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.

No deficiencies cited. Copy of report provided to Ms. Gaytan.

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Angelica Rea	TELEPHONE: (323) 980-4929
LICENSING EVALUATOR SIGNATURE:	DATE: 01/19/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/19/2024

LIC9099 (FAS) - (06/04)

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