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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 191500609
Report Date: 06/16/2026
Date Signed: 06/16/2026 03:54:36 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
06/11/2026 and conducted by Evaluator Blanca Gonzalez
COMPLAINT CONTROL NUMBER: 28-AS-20260611164108
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: 109DATE:
06/16/2026
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Administrator Priscilla GaytanTIME COMPLETED:
04:10 PM
ALLEGATION(S):
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Staff does not prevent resident from being harassed by another resident in care.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Blanca Gonzalez conducted an unannounced initial 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: LPA Gonzalez conducted an initial complaint visit, requested and obtained copies of Resident Roster, Staff Roster, interviewed staff 1- 6 (S1-S6) and interviewed residents 1- 8 (R1-R8). LPA reviewed files for R1 and R2 and obtained copies of Admission Agreement, physician’s report, ID/face sheet, care plan meeting notes and staff notes.
continued on LIC 9099C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Blanca Gonzalez
LICENSING EVALUATOR SIGNATURE:

DATE: 06/16/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2026
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 2
Control Number 28-AS-20260611164108
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: 06/16/2026
NARRATIVE
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Regarding allegation “Staff does not prevent resident from being harassed by another resident in care,” it was reported that R1 is tired of being harassed by R2 and R1 is tired of the racial slurs and inappropriate comments made by R2. LPA interviewed 6 staff. 6 out of 6 staff interviewed deny the allegation. S1 stated staff have spoken to R1 and R2 about the incident. R2’s family has been notified and R2 has been offered counseling. S1 stated staff conduct health and safety checks every 2 hours. S2 stated R1 and R2 have been separated by relocating to different rooms, down separate hallways. S2 stated they have spoken to R2 regarding boundaries and inappropriate language. S2 stated the police department was called, they spoke with R2 but did not leave a report. LPA interviewed 8 residents. 8 out 8 residents interviewed denied the allegation. R1 stated staff are handling the incident. R3 stated they reported an incident to staff and “staff were on it.” R3 stated staff addressed the incident and are taking care of the situation. R5 stated there was an issue but staff took care it, “It’s what they do. It’s their job and they do it.” R6 stated “staff are aware of the incident and they are handling it.”

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

SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Blanca Gonzalez
LICENSING EVALUATOR SIGNATURE:

DATE: 06/16/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2026
LIC9099 (FAS) - (06/04)
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