191500609-4-4-2024-28-AS-RORN-D6LNCB-20240626102027

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 191500609
Report Date: 04/04/2024
Date Signed: 04/04/2024 05:03:35 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
03/27/2024 and conducted by Evaluator Bonnie Tao

COMPLAINT CONTROL NUMBER: 28-AS-20240327143451

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: 126	DATE:	04/04/2024
		UNANNOUNCED	TIME BEGAN:	08:00 AM
MET WITH:	Priscilla Gaytan, administrator and Anne Graves, LVN supervisor		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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Staff do not address healthcare needs of resident.
Staff allow resident to be left in soiled clothing for an extended period of time.
Staff do not ensure resident is provided with fresh clean linens.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Tao conducted an unannounced 10-day complaint visit to this facility. Upon arriving at the facility, LPA met Priscilla Gaytan, administrator and Anne Graves, LVN supervisor. LPA explained the purpose of today’s visit and discussed the allegations mentioned above.

The investigation consisted of residents/ staff interviews, facility tours, and review of facility records. LPA obtained resident/staff roster, staff’s training records and residents’ facility files.

The investigation revealed the following:
In regards of facility staff do not address healthcare needs of resident, it is alleged staff do not address resident’s rash. LPA attempted but failed to interview resident#1 (R1). Per resident interviews, eight (8) out of ten (10) residents who were interviewed could not corroborate the allegation. Two (2) out of ten (10) residents declined to be interviewed. Resident interviews revealed that staff would conduct skin assessment weekly and address their healthcare needs to medical professional. (-continued in LIC 9099C-)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981-3981
LICENSING EVALUATOR NAME: Bonnie Tao	TELEPHONE: (323) 981-3971
LICENSING EVALUATOR SIGNATURE:	DATE: 04/04/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/04/2024

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-20240327143451

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: 04/04/2024

NARRATIVE

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Staff would check on them when changing their clothes or bathing them. Seven (7) out of seven (7) staff denied the allegation. Staff interviews revealed that staff would conduct skin assessment to residents, report the result to administrator and nurses, and provide care to residents accordingly. Per record review, staff would report skin assessment to LVN. Per observation, residents looked fine and decent. They were able to verbalize their skin issue. Therefore, there is not preponderance of evidence to show staff failed to address resident’s healthcare needs while in care.

In regard to allegation staff allow resident to be left in soiled clothing for extended period of time, it is alleged that staff left resident in soiled clothing for extended periods of time. Per resident interviews, eight (8) out of ten (10) residents who were interviewed could not corroborate the allegation. Two (2) out of ten (10) residents declined to be interviewed. Resident interviews revealed that they had never left in soiled clothing. Staff changed their clothes timely if clothes got soiled. All seven (7) staff denied the allegation. Staff interviews revealed that staff would change residents’ clothes daily/ as needed. As LPA observed, residents looked clean and neat. Therefore, resident was not left in soiled clothing for extended period of time.

In regard to allegation staff do not ensure resident is provided with fresh clean linens, it is alleged that staff do not change resident’s bedsheets. Eight (8) out of ten (10) residents who were interviewed could not corroborate the allegation. Two (2) out of ten (10) residents declined to be interviewed. Resident interviews revealed their bedsheets were changed daily, weekly or as needed when soiled. Staff changed residents’ bedsheets timely when after soiled. All seven (7) staff denied the allegation. Staff interviews revealed that staff would change residents’ bedsheet at least once weekly and/or as needed. Per observation, residents’ bedsheets and rooms were observed to be clean. Therefore, clean linens were provided to residents.

Based on the information obtained during the investigation, interviews with staff, residents, review of resident files and LPA's observation, the investigation did not reveal any evidence to support the allegations mentioned above.

Although the allegations may have happened or are valid, there is not preponderance of evidence to prove the alleged violations did or did not occur, therefore, the allegation is UNSUBSTANTIATED.

An exit interview was conducted with Anne, LVN supervisor. The findings were discussed. A copy this report was provided at time of the visit.

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981-3981
LICENSING EVALUATOR NAME: Bonnie Tao	TELEPHONE: (323) 981-3971
LICENSING EVALUATOR SIGNATURE:	DATE: 04/04/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/04/2024

LIC9099 (FAS) - (06/04)

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