198603710-9-12-2024-28-AS-RORN-D99VEC-20240919162206

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603710
Report Date: 09/12/2024
Date Signed: 09/12/2024 04:58:18 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
09/06/2024 and conducted by Evaluator Luis Mora

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20240906142814

FACILITY NAME:	BAYSHIRE SAN DIMAS		FACILITY NUMBER:	198603710
ADMINISTRATOR:	COLEMAN, CHAD		FACILITY TYPE:	741
ADDRESS:	1740 S SAN DIMAS		TELEPHONE:	(909) 394-0304
CITY:	SAN DIMAS	STATE: CA	ZIP CODE:	91773
CAPACITY:	119	CENSUS: 42	DATE:	09/12/2024
		UNANNOUNCED	TIME BEGAN:	11:38 AM
MET WITH:	Lisa Gomez		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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Facility air conditioner is in disrepair
Staff does not provide comfortable room temperature for residents

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Luis Mora conducted an unannounced initial complaint visit to determine the validity of the above-mentioned allegations. LPA met with Lisa Gomez (Manager) and explained the reason for the visit.

The investigation consisted of the following: LPA Mora requested for copies of the staff and resident rosters, and interviewed the Manager, Staff 1 - Staff 3 (S1 - S3), Resident 1 - Resident 8 (R1 - R8) and third party AC contractor. LPA also toured common areas and rooms 154, 227, 232, 233, 243, 317, 319, and 340

Regarding the allegation "facility air conditioner is in disrepair" and "staff does not provide comfortable room temperature for residents", it is alleged that the AC has been in disrepair for the past few months and multiple residents rooms and dining room have been affected. (Continued to LIC 9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Wei Siew Ho	TELEPHONE: (323) 981-3969
LICENSING EVALUATOR NAME: Luis Mora	TELEPHONE: 323-981-3964
LICENSING EVALUATOR SIGNATURE:	DATE: 09/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2024

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-20240906142814

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: BAYSHIRE SAN DIMAS	FACILITY NUMBER: 198603710
	VISIT DATE: 09/12/2024

NARRATIVE

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Administrator and staff interviewed stated that the recent heat wave did cause some AC issues, but they immediately contacted a third party AC contractor to come and repair the AC issues. Administrator stated that portable AC were provided to residents affected to maintain a comfortable temperature. The third party AC contractor was interviewed and stated that it is normal for buildings like this facility to have AC problems here and there, but recently the heat wave caused a lot of AC units to stop working properly. The facility contacted him and he came to the facility on 09/06/24, 09/07/24, 09/08/24, 09/09/24 and 09/11/24. He stated he brought portable AC to install in rooms and areas that were affected while he worked on fixing the AC units. Every resident room has their own AC unit and thermostat. Six (6) out of eight (8) residents interviewed did not had any AC issues and had no complains about the temperature in their rooms. Two (2) of the eight (8) residents stated that their AC was blowing air, but not cold enough air especially during the recent heat wave, however, the facility provided them with a portable AC. LPA observed the thermostat in these 8 residents room and saw temperatures between 72 degrees F and 78 degrees F. Per Title 22 Section 87303(b)(2) and Section 87303(b)(3), the facility shall cool rooms to a comfortable range, between 78 degrees F (26 degrees C) and 85 degrees F (30 degrees C), however, nothing in this section shall prohibit residents from adjusting individual thermostatic controls. LPA confirmed with the 8 residents if they were comfortable with the temperature showing on their thermostat and they stated they were. The residents are able to adjust the temperature in their bedrooms to their liking. Five (5) out of the eight (8) residents interviewed stated the temperature in the dining room was comfortable. Three (3) out of the (8) residents stated it was hot or warm in the dining room. These three residents stated that the temperature showing on the dining room thermostat showed temperatures of 81, 82, and 83 degrees F. These temperatures provided are within the temperature range per Title 22 Section 87303(b)(2). During today's visit, LPA observed a temperature of 78 degrees F in the dining room thermostat.

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 the report was provided

SUPERVISOR'S NAME: Wei Siew Ho	TELEPHONE: (323) 981-3969
LICENSING EVALUATOR NAME: Luis Mora	TELEPHONE: 323-981-3964
LICENSING EVALUATOR SIGNATURE:	DATE: 09/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2024

LIC9099 (FAS) - (06/04)

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