191500609-4-16-2026-28-AS-WSHO-DTYS9E-20260511134039

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 191500609
Report Date: 04/16/2026
Date Signed: 04/16/2026 03:58:58 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
02/17/2026 and conducted by Evaluator Blanca Gonzalez

COMPLAINT CONTROL NUMBER: 28-AS-20260217085938

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: 115	DATE:	04/16/2026
		UNANNOUNCED	TIME BEGAN:	12:50 PM
MET WITH:	Wellness Director Anne Graves		TIME COMPLETED:	04:10 PM

ALLEGATION(S):

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Staff did not assist resident with dentist needs
Facility is unsanitary
Staff is unresponsive to resident's family inquiry
Staff did not ensure refrigerator in resident's room was maintained in operable condition

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Blanca Gonzalez conducted an unannounced subsequent complaint investigation visit regarding the above allegations. LPA Gonzalez was greeted by staff and the purpose of the visit was explained. Wellness Director Anne Graves assisted LPA with the tour.
The investigation consisted of the following: On 02/24/2026, LPA Gonzalez conducted an initial complaint visit, requested and obtained copies of Resident Roster, Staff Roster, maintenance logs, and pest control service logs. LPA toured the facility physical plant, inspected residents’ rooms, reviewed file for R1, interviewed staff 1- 5 (S1-S5) and interviewed residents 1- 5 (R1-R5). During today’s visit LPA interviewed staff 6-7 (S6-S7), residents 6-9 (R6-R9) and inspected four (4) additional resident rooms.
continued on LIC 9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Blanca Gonzalez
LICENSING EVALUATOR SIGNATURE:	DATE: 04/16/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/16/2026

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-20260217085938

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: 04/16/2026

NARRATIVE

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The investigation revealed the following: Regarding allegation “Staff did not assist resident with dentist needs,” it was reported that facility staff have not assisted R1 with seeing a dentist to replace their missing dentures, R1 was missing top and bottom dentures and dental follow up has been repeatedly delayed. Interview with R1 revealed R1 stated they have attended dental appointments and have received new dentures. R1 was not able to confirm if they had missed any dental appointments. LPA reviewed documents for dental appointments scheduled for R1 for 08/22/25 impressions for dentures, 10/10/25 bite registration for dentures, 10/22/25 (rescheduled to 10/28/25) try on dentures, 01/27/26 pick up dentures and 02/16/26 adjustment to dentures. 6 out of 9 residents interviewed stated staff help make appointments and arrange transportation for appointments. 2 out of 9 residents stated they make their own appointments or family make appointments for them.

Regarding allegation “Facility is unsanitary,” it was reported that staff have not treated R1’s room for bugs even though the resident and the family have made multiple requests and staff did not address the unsanitary refrigerator in R1’s room that had an odor when opened. Interview with R1 revealed R1 stated they notified maintenance of a bug on the wall and maintenance “came and sprayed.” LPA reviewed maintenance log dated 02/08/26 indicating R1’s room was treated for bugs in room. LPA reviewed invoices for biweekly pest control services. Invoice dated 02/10/26 indicated R1’s room had been serviced for pest control, “no pest activity found inside the room.” 6 out of 9 residents interviewed stated they had not seen bugs in their rooms. R1 stated their refrigerator was working. LPA opened R1’s refrigerator and observed it to be clean and odorless at the time of visit. 9 out of 9 residents interviewed stated housekeeping cleans their room everyday and deep clean their room once a week which includes cleaning the refrigerator.

continued on LIC 9099C

SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Blanca Gonzalez
LICENSING EVALUATOR SIGNATURE:	DATE: 04/16/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/16/2026

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 28-AS-20260217085938

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: 04/16/2026

NARRATIVE

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Regarding allegation “Staff is unresponsive to resident family's inquiry,” it was reported that staff is unresponsive to family’s request. Interviews with staff revealed that due to confidentiality, staff will only report resident information to residents and their responsible party on file. LPA interview with staff and review of R1’s facility file revealed staff are in contact with R1’s responsible party on record. 8 out of 9 residents interviewed stated that they have not had any issues with staff reporting to the residents or their responsible party.

Regarding allegation “Staff did not ensure refrigerator in resident's room was maintained in operable condition,” it was reported that staff have not fixed the refrigerator that came with R1’s room that stopped working. Interview with R1 revealed R1 stated their refrigerator is working. LPA inspected R1’s refrigerator and observed it to be operable at the time of visit. Interviews with staff revealed they did not have any work orders to repair or replace a refrigerator for R1. LPA reviewed maintenance logs and did not see any request for repair or replacement of a refrigerator for R1. 8 out of 9 residents interviewed indicated their facility-provided refrigerator is functional and have not had any problems.

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.

An exit interview was conducted, and a copy of this report was provided to Wellness Director Anne Graves.

SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Blanca Gonzalez
LICENSING EVALUATOR SIGNATURE:	DATE: 04/16/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/16/2026

LIC9099 (FAS) - (06/04)

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