191500609-5-1-2026-28-AS-WSHO-DTYNFB-20260511102515

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 191500609
Report Date: 05/01/2026
Date Signed: 05/01/2026 10:45:19 AM

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
04/20/2026 and conducted by Evaluator Blanca Gonzalez

COMPLAINT CONTROL NUMBER: 28-AS-20260420155443

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:	DATE:	05/01/2026
		UNANNOUNCED	TIME BEGAN:	10:22 AM
MET WITH:			TIME COMPLETED:	11:00 AM

ALLEGATION(S):

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Staff do not provide a safe environment for residents.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Blanca Gonzalez conducted an unannounced subsequent complaint investigation visit regarding the above allegation. LPA Gonzalez was greeted by staff and the purpose of the visit was explained.

The investigation consisted of the following: On 04/28/2026, LPA Gonzalez conducted an initial complaint visit, requested and obtained copies of Resident Roster, Staff Roster, interviewed staff 1- 8 (S1-S8) and interviewed residents 1- 11 (R1-R11). LPA reviewed files for R1 and R2 and obtained copies of Admission Agreement, physician’s report, ID/face sheet and staff notes. During today’s visit LPA delivered findings.
continued on LIC 9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Blanca Gonzalez
LICENSING EVALUATOR SIGNATURE:	DATE: 05/01/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2026

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-20260420155443

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: 05/01/2026

NARRATIVE

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Regarding allegation “Staff do not provide a safe environment for residents,” it was reported that a resident received numerous explicit, graphic and harassing voicemail messages from another resident and when reported to staff, no action was taken. R1 stated they had not given R2 their phone number and was not able to confirm how R2 had gotten R1’s phone number. R1 stated the calls were received by a private number. S1 and S2 stated R1 was provided emotional support and S2 offered to call the Sheriff. The Sheriff indicated that there was no evidence to prove that it was R2. The Sheriff stated they would have a conversation with R2 asking them not to call R1. R2 denied calling R1. S2 heard the voicemails but was unable to identify the caller’s voice to be R2’s. S3, S4, S5 and S7 indicated when residents complain about having conflicts with other residents, staff try to resolve the issue by talking to the residents and come to a common understanding between the residents and report the issue to supervisors. Staff also indicated complaints have been minor and did not involve law enforcement. 10 out of 11 residents interviewed indicated they feel safe at the facility. R3 stated they feel very safe. R4 stated they feel safe and just avoid obnoxious people. R3, R5, R7, R9, and R10 stated they have not had any problems with other residents and have not had to report any conflicts with other residents to staff. R11 stated they had a situation with R2 but R11 asked R2 to leave them alone. R11 stated R2 has done what was asked by R11 and R11 has not had any problems with R2. R11 did not feel the need to report the situation to staff. R11 stated they feel safe at the facility.

Based on interviews and record review, although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated.

SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Blanca Gonzalez
LICENSING EVALUATOR SIGNATURE:	DATE: 05/01/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2026

LIC9099 (FAS) - (06/04)

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