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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 191500609
Report Date: 01/03/2025
Date Signed: 01/03/2025 12:53:27 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
12/11/2024 and conducted by Evaluator Kimberly Ramirez
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20241211143313
FACILITY NAME:SAN DIMAS RETIREMENT CENTERFACILITY NUMBER:
191500609
ADMINISTRATOR:PRISCILLA GAYTANFACILITY TYPE:
740
ADDRESS:834 WEST ARROW HIGHWAYTELEPHONE:
(909) 599-8441
CITY:SAN DIMASSTATE: CAZIP CODE:
91773
CAPACITY:343CENSUS: 129DATE:
01/03/2025
UNANNOUNCEDTIME BEGAN:
07:56 AM
MET WITH:Administrator Priscilla GaytanTIME COMPLETED:
04:00 PM
ALLEGATION(S):
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Facility staff leave residents in urine soaked clothing for an extended period of
time.
Facility staff did not provide resident with linens in good clean condition.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Kimberly Ramirez conducted an unannounced subsequent complaint investigation visit on 01/03/2025 regarding the above allegations. LPA Gutierrez conducted an unannounced initial complaint investigation visit on 12/19/2024, and a needs further investigation was documented. LPA was greeted by Administrator Priscilla Gaytan and explained the purpose of the visit.

The investigation consisted of the following: LPA Ramirez requested and obtained copies of Resident/Client Roster, Staff roster, Staff#1 - 7 interviews (S1 – S7), Interview of Resident#1-10 (R1 – R10), Incontinence resident roster, and physical plant tour.

SEE 809-C
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Kimberly Ramirez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 01/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/03/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 28-AS-20241211143313
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: 01/03/2025
NARRATIVE
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The investigation revealed the following: Regarding allegations: Facility staff leave residents in urine soaked clothing for an extended period of time- It is alleged facility staff leave residents in urine soaked clothing. Ten (10) out of ten (10) residents interviewed deny this allegation. Seven (7) out of (7) staff interviewed deny this allegation. During resident interviews, LPA Ramirez observed residents to be well groomed, clothing appeared to be neat and clean, and resident rooms were not observed to be malodorous. 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.

Facility staff did not provide resident with linens in good clean condition- It is alleged facility staff do not provide residents with clean linen. Ten (10) out of ten (10) residents interviewed deny this allegation. Seven (7) out of (7) staff interviewed deny this allegation. LPA Ramirez toured ten (10) resident rooms at random. During tour, LPA Ramirez observed ten (10) out of ten (10) resident rooms to contain required linen. Linen appeared to be clean and not malodorous. LPA Ramirez observed signs posted on the inside or each resident room indicating when personal laundry and linen will be washed by housekeeping. LPA Ramirez observed a linen and personal laundry schedule in the facility laundry room. LPA Ramirez observed extra linen and bedding in the facility laundry room. 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.

No violations were observed during this instigation complaint. Exit interview was conducted and a copy of this report was provided via email.
NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Kimberly Ramirez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 01/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/03/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2