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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 191500609
Report Date: 03/21/2025
Date Signed: 03/21/2025 01:25:26 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
03/14/2025 and conducted by Evaluator Bennette Pena
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20250314143441
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: 124DATE:
03/21/2025
UNANNOUNCEDTIME BEGAN:
10:08 AM
MET WITH:Priscilla Gaytan - AdministratorTIME COMPLETED:
01:30 PM
ALLEGATION(S):
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Staff are not safeguarding residents personal belongings.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Bennette Pena conducted an unannounced 10-day complaint visit for the allegation listed above. LPA met with Kaitlin Antunez, Receptionist and explained the purpose of the visit. At 10:30am, Priscilla Gaytan, Administrator arrived and assisted LPA.

The investigation consisted of the following: LPA obtained copies of Resident and Staff Rosters, Staff in-service training regarding residents rights/safety, room safety & room cleanliness (03/03/2025), theft & loss policy and screenshot of the report of the missing items by R1's family member. LPA also conducted a tour of facility and common areas. LPA reviewed and obtained files for Resident #1 (R1) such as Identification and Emergency Information Sheet, Residency Agreement (05/01/2024), Physician's Report (11/19/2024), Resident Appraisal, Resident Personal Property and Valuables Sheet and Inventory List and Individual Service Plan (ALW). Between 10:35am-12:30pm, LPA interviewed Resident #1 (R1) - Resident #13 (R13) and Staff #1 (S1)- Staff #5 (S5).
*****CONTINUED ON LIC9099-C*****
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Bennette Pena
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/21/2025
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-20250314143441
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: 03/21/2025
NARRATIVE
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The investigation revealed the following:

In regards to the allegation:Staff are not safeguarding residents’ personal belongings.” It is alleged that R1 has had small things missing from her room over the last few months and that staff don't always lock the door after performing the safety check, and that R1’s door is unlocked when she comes back from shopping. Interviews conducted with (5) out of (5) staff members stated that in-service training regarding resident safety, resident rights, theft & loss and room safety/cleanliness are being conducted to staff members regularly. All staff interviewed stated that there have been no issues or complaints brought to their attention regarding missing items from residents and doors being left unlocked lately. However, S1 stated that on 01/29/2025, R1's family member reported to S1 that R1 was missing some of her personal belongings that happened on 01/05/2025 between 2am and 11:30am. S1 reviewed the video footage based on the time frame given to them and did not find any signs of theft during their internal investigation. As a precaution, S1 recommended a lock box for R1’s items, but R1 declined. Some staff interviewed also stated that some residents would report that they are missing items, although residents forget where they placed them and later finds the items. S2 stated that she conducts room safety training to staff on a monthly basis and will continue to remind the housekeeping staff to ensure that regardless of the residents’ presence, they must secure/lock the residents’ doors after performing safety checks if the residents prefer their rooms locked. A total of 13 residents were interviewed, (12) out of (13) residents interviewed indicated that they do not have any issues with lost belongings and they feel safe living in the facility. Interviews conducted with (12) residents revealed that the facility staff respect their belongings and have never taken any of their belongings. Interview with R1 stated that some of her minor items had gone missing over time, but no cash or jewelry was lost. Interview conducted with W1 indicated that W2 did not want to seek reimbursement for R1’s missing items. LPA observed that residents have a key to their room and some residents keep their door opened and/or unlocked. LPA also observed that R1 occupies a private room on the 2nd floor, without a roommate and there are cameras in the hallways and common areas. Based on record review, the alleged missing items are not listed on R1’s personal Inventory list and that there was no police report filed for the missing items.Based on statements and interviews conducted with residents and staff as well as reviewed files and documentation, there was not enough supportive evidence to corroborate the allegation.

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 conducted and a copy of this report was provided to Priscilla Gaytan, Administrator.
NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Bennette Pena
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/21/2025
LIC9099 (FAS) - (06/04)
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