191500609-8-7-2026-28-AS-DSIS-DXSM6K-20260910092001

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 191500609
Report Date: 08/07/2026
Date Signed: 08/07/2026 03:23:22 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
08/05/2026 and conducted by Evaluator Tena Herrera

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20260805181015

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: 107	DATE:	08/07/2026
		UNANNOUNCED	TIME BEGAN:	08:42 AM
MET WITH:	Karen Meacham – Assistant Administrator		TIME COMPLETED:	03:23 PM

ALLEGATION(S):

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Staff are not ensuring a safe environment for resident.
Staff are not ensuring resident is provided medication as prescribed.
Staff are not ensuring that resident is attending appointments.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Tena Herrera conducted an unannounced complaint visit to investigate the allegations listed above. LPA met with Karen Meacham and explained the reason for the visit.

The investigation consisted of the following:

LPA obtained copies of staff and residents, copies of R2’s behavioral contract, conducted a medication review, and completed interviews with 4 Staff (S1-S4) and 10 Residents (R1-R10).

(Continued on LIC9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Tena Herrera
LICENSING EVALUATOR SIGNATURE:	DATE: 08/07/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2026

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-20260805181015

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: 08/07/2026

NARRATIVE

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The investigation revealed the following:

Allegation: Staff are not ensuring a safe environment for resident.

It is alleged that R1’s significant other has displayed controlling and aggressive behavior toward R1 and staff does not prevent this from happening. LPA conducted interviews with 4 Staff, and each denied the allegation, staff stated that although R2 does have controlling behaviors, this is the spouse and next of kin for R1 and R1 has not stated they are fearful of R2. LPA reviewed R2’s Care Meeting Plan, Behavioral Contract and meeting notes that revealed R1 has been spoken to on 6/16/26, 6/24/26, 7/17/26 and 7/7/26 and R1’s verbally aggressive behaviors and interference with R1’s choices to attended activities were discussed and R1 agreed to discontinue this behavior. Per S1 and S3-S4, there was a meeting conducted 8/6/26 with R1, R2 and W1 where it was agreed that R2 will stop interfering with R1’s ADL’s, medication and doctors’ appointments and all parties agreed that R1 should move to the Memory Care wing at the facility but still be able to spend the day with R2, this move is scheduled for next week. LPA interviewed 10 Residents and each denied the allegation and stated that they feel safe at the facility.

Allegation: Staff are not ensuring resident is provided medication as prescribed.

It is alleged that R1’s significant other interferes with R1 receiving their medications. LPA conducted a medication review and all of R1's medication was accounted for and appear to be administered as prescribed. LPA interviewed 4 Staff and each denied the allegation, S1 and S3-S4 stated that R2 has interfered with medication being given to R1, that when it was time for medication they would encourage R1 to refuse the medication because they are still sleeping and haven’t eaten breakfast. Staff stated that the pharmacy and doctors were notified and they were able to change the medication time to a later time since R1 & R2 tend to sleep in late, the doctors changed the time for the medication as an attempt to have residents be more compliant with medication and this has been working. LPA interviewed 10 Residents and each denied the allegation and stated that they are always assisted with medications, medications are administered as prescribed, staff has never refused assisting with medication and staff re-fill their medications as needed.

(Continued on LIC9099-C)

SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Tena Herrera
LICENSING EVALUATOR SIGNATURE:	DATE: 08/07/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2026

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20260805181015

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: 08/07/2026

NARRATIVE

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Allegation: Staff are not ensuring that resident is attending appointments.
It is alleged that R1’s significant other interferes with R1 attending scheduled appointments. LPA conducted interviews with 4 Staff, and each denied the allegation, staff stated that R2 was interfering with a doctor appointment for R1 as they did not want R1 in the van with the male driver, they were able to reschedule the appointment and also scheduled an appointment with the same doctor for R2, both residents went in transporting vehicle with driver, attended their appointments and moving forward this option will be made available so both residents can attend the appointments together. LPA interviewed 10 Residents and each denied the allegation and stated staff assist with both setting their doctor appointment and transportation to and from their appointment, residents also stated they are reminded of their upcoming appointments by staff.

Based on statements and interviews conducted with Staff/Residents, review of resident files and facility file records, there was not enough supportive evidence to concur with the reported allegations. 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. Exit interview held, and a copy of this report was provided.

SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Tena Herrera
LICENSING EVALUATOR SIGNATURE:	DATE: 08/07/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2026

LIC9099 (FAS) - (06/04)

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