191500609-8-26-2025-28-AS-FFIS-DLP3DU-20250919181007

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 191500609
Report Date: 08/26/2025
Date Signed: 08/26/2025 05:09:48 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
08/18/2025 and conducted by Evaluator Cynthia D Chan

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20250818151203

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: 118	DATE:	08/26/2025
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Anne Graves, LVN Supervisor		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Staff stole resident’s money and personal belongings.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Cynthia Chan conducted a complaint investigation regarding the allegation listed above. LPA arrived unannounced and met with Staff, Esmeralda Lerma. The purpose of the visit was explained.

LPA obtained copies of the staff and resident rosters and reviewed documents. Interviews were conducted with Staff #1 - #6, and Residents #1 - #10.

Allegation - Staff stole resident’s money and personal belongings. It is reported that on 8/2/25, staff stole $1,000 from Resident #1’s key safe and other personal items such as perfume, Phone cord, and K-cups. According to staff interviews, they were not aware that Resident #1 (R1) was keeping money at the facility.

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: 08/26/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2025

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-20250818151203

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: 08/26/2025

NARRATIVE

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Staff stated R1 does not require staff assistance and only obtains housekeeping service. Staff indicated that R1 declined to have caregivers check on R1 in the evening during their 2-hour rounds. R1’s personal property and valuable form list does not include the alleged stolen personal items or cash entrusted to the facility to safeguard. A police report was filed for this alleged incident on 8/2/25.
LPA interviewed ten (10) residents today. Three (3) out of ten (10) residents stated they have missing or stolen items from their rooms. Two of the three residents who had missing items believed that staff stole their cash and belongings. The resident, who stated cash was stolen, kept it in a safe and did not disclose to staff that money is being kept at the facility until the alleged incident. Residents stated they have a key to their room, and many will lock the door when they leave.
During the visit today, LPA reviewed the surveillance footage for dates 8/1/25 – 8/2/25. Footage showed that caregivers, a housekeeper, and a resident had visited R1’s room. However, there was no evidence to show that a person entered the room when R1 was not present. Based on the information gathered, there is no supporting evidence to state that staff stole the resident’s money and personal belongings.

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.

An exit interview was conducted with Anne Graves. 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: 08/26/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2025

LIC9099 (FAS) - (06/04)

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