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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 191500609
Report Date: 07/09/2025
Date Signed: 07/09/2025 04:28:22 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 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
06/30/2025 and conducted by Evaluator Mayra Cota
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20250630141209
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: 109DATE:
07/09/2025
UNANNOUNCEDTIME BEGAN:
09:04 AM
MET WITH:Priscilla M. Gaytan, AdministratorTIME COMPLETED:
04:30 PM
ALLEGATION(S):
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Staff did not prevent an altercation between residents in care.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA), Mayra Cota, conducted an unannounced initial 10-day investigation visit. LPA Cota met with Priscillla Gaytan and the purpose for the visit was explained.

The investigation consisted of the following:

On 7/9/25, LPA Cota, toured the facility, obtained copies of client and staff rosters, conducted interviews with Residents #1-10 and Staff #1-7. Resident record review was also conducted and copies of relevant documents were also obtained.

****Continues on LIC 9099-C
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Mayra Cota
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2025
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-20250630141209
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: SAN DIMAS RETIREMENT CENTER
FACILITY NUMBER: 191500609
VISIT DATE: 07/09/2025
NARRATIVE
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The investigation revealed the following:

Regarding allegation: Staff did not prevent an altercation between residents in care.

It is alleged that staff witnessed an incident between residents in which residents were shouting and using racial slurs, and that staff did not prevent the altercation from happening. Staff #1-7 (S1-S7) deny the allegation. Interviews with S1-S7 revealed, although residents sometimes are involved in verbal altercations between each other, staff are taking measures to prevent incidents from escalating. S1-S7 stated, they intervene by redirecting residents into regulating their frustrations with open communication and by guiding them into expressing their feelings appropriately. Staff also stated residents are encouraged to report incidents so that they are handled immediately by staff. Nine (9) out of (10) resident interviews indicated, verbal altercations occur between residents; however, they know they can express their concerns to staff and staff will talk to residents exhibiting verbal aggression. Nine (9) out of (10) residents interviewed stated; staff take measures to prevent verbal altercations from escalating into physical aggression between residents by talking to parties involved on a one to one basis, privately. Residents stated, staff encourage residents to report any type of aggression to administrative staff. Residents also stated, although verbal altercations are common among residents, staff intervene to calm the situations which have not become physical. Staff and resident interviews, do not corroborate the allegation.

Although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is UNSUBSTANTIATED. An exit interview was conducted with Priscilla Gaytan, Administrator, and a copy of this report was provided.
NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Mayra Cota
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2025
LIC9099 (FAS) - (06/04)
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