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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 191500609
Report Date: 07/24/2025
Date Signed: 07/24/2025 06:07:26 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
07/15/2025 and conducted by Evaluator Cynthia D Chan
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20250715133005
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: 118DATE:
07/24/2025
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Karen Meacham, Co-AdministratorTIME COMPLETED:
05:00 PM
ALLEGATION(S):
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1. Unlawful Eviction.
2. Facility did not prevent resident from being harassed by other residents.
3. Facility failed to maintain resident's citizenship documents.
4. Staff does not respond to resident’s call button in a timely manner.
5. Facility is opening residents' mail before providing it to them.
6. Facility is not providing adequate food service.
7. Facility is failing to coordinate and provide transportation for residents to their medical appointments.
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs) Cynthia Chan and Elena Mallett conducted a complaint investigation on the allegations listed above. LPAs arrived unannounced and met with the Co-Administrator, Karen Meacham. The purpose of the visit was explained.

The investigation consisted of the following:
LPAs obtained a copy of the staff and resident rosters. LPA toured the facility and interviewed the Administrators, five (5) Staff, and ten (10) Residents. Resident #1 (R1) is no longer residing at the facility, and attempt to interview R1 was made.

The investigation revealed the following:
Allegation – unlawful eviction. It is alleged that Resident #1 (R1) was issued an eviction letter for reasons that were untrue. LPA interviewed the administrators and staff.
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Cynthia D Chan
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2025
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 3
Control Number 28-AS-20250715133005
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: 07/24/2025
NARRATIVE
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Administrators indicated the reasons listed on the eviction letter were true and have witnesses to confirm the dates of occurrences. Per the administrators, they have tried working with R1 and had a behavioral contract in place. However, R1’s conduct has not improved and has escalated in severity. Some staff interviewed have observed R1 being verbally aggressive and harassing others. LPA obtained and reviewed the 30-day eviction letter that was issued to R1 on 6/23/25. The eviction letter included the specific facts for the cause of eviction. The residents interviewed today have not received any eviction notices.

Allegation - Facility did not prevent resident from being harassed by other residents. It is alleged that the administrators are not preventing R1 from being harassed by the 4 female residents. Administrators were not aware of R1 being harassed by other residents until recent. Administrators stated that staff will intervene immediately if they observe any inappropriate behaviors or altercations. Administrators will address any issues between residents individually and will not disclose to other residents what is being done. Staff interviewed stated that they are always monitoring residents and ensuring their safety. Staff will try to de-escalate any situations amongst residents when they need to and ask residents to stop the inappropriate talks. Ten out of ten residents stated that they have seen staff intervene right away if there are any issues among residents.

Allegation - Facility failed to maintain resident's citizenship documents. It is alleged that the administrator was safeguarding R1’s citizenship document, and when asked, the administrator either lost or misplaced it. LPA interviewed the administrators, who both stated they did not recall R1 asking them to safeguard any documents. Both stated that R1 had requested it right before moving out; however, administrators informed R1 that they did not keep any documents of such in their office and that they do not have a safe as alleged. Administrators stated that they would have documented it on their safeguarding/valuable form if they kept it. Ten out of ten residents have not asked the administrators to keep anything for them. Residents stated they stored their belongings and valuables in their rooms.

Allegation - Staff does not respond to the resident’s call button in a timely manner. It is alleged that staff did not respond to a fall for up to 2 hours due to staff not available. Administrators stated that every room is equipped with pull cords by their bedside and in the bathrooms. When a resident pulls the cord, it alerts the front desk, and the receptionist will respond to the call. The receptionist will call for a staff to assist the resident right away. Caregivers have walkie-talkies that they carry throughout their shifts. Staff interviewed stated they respond to calls right away and do room checks at least every 2 hours. LPA interviewed ten residents, and all the residents stated that the staff assist them right away when they call for them.

NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Cynthia D Chan
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 28-AS-20250715133005
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: 07/24/2025
NARRATIVE
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Allegation - Facility is opening residents' mail before providing it to them. Administrators and staff interviewed have not opened any of the residents’ mail. Staff stated that residents’ mail is placed in their mailboxes. The residents who reside in the Garden area get their mail from the front desk. Ten out of ten residents have not received opened mail.

Allegation - Facility is not providing adequate food service. It is alleged that staff is preventing residents from getting second helpings of food, no extra desserts, and causing residents to go hungry. Administrators and staff interviewed denied this allegation and stated that residents are given extra servings if they want. Staff stated that when residents want extra of something, they would inform the kitchen staff to get it for them. The menu lists the food items for the day. In addition, the facility has an alternative menu that residents can select from. Ten out of ten residents stated they are given additional servings if they want. However, many stated the portion amount is sufficient and do not request more.

Allegation - Facility is failing to coordinate and provide transportation for residents to their medical appointments. LPA interviewed the administrators and staff, who stated there is a Social Services Aide who assists residents with making their medical appointments and arranging transportation. Staff have not heard of residents’ medical appointments being cancelled last minute or that residents were not informed of their appointments. Residents who have upcoming appointments are given a slip indicating the appointment time and date. The staff will speak to residents directly a week before to remind them of the appointments and provide them with a slip, which states the transportation pick up date and time and the doctor’s contact information. Seven out of ten residents stated the facility assists with coordinating and transporting them to their medical appointments. Two of the residents arrange their own medical appointments and transportation, while one did not respond to this allegation.

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.



An exit interview was conducted with Administrator, K. Meacham. A copy of this report, along with the appeal rights, was provided.
NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Cynthia D Chan
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3