191500609-10-6-2025-28-AS-LHIS-DMMPBA-20251020111001

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 191500609
Report Date: 10/06/2025
Date Signed: 10/06/2025 04:04:55 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
06/13/2025 and conducted by Evaluator Tena Herrera

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20250613111812

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: 116	DATE:	10/06/2025
		UNANNOUNCED	TIME BEGAN:	09:16 AM
MET WITH:	Karen Meacham – Administrator		TIME COMPLETED:	04:20 PM

ALLEGATION(S):

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Staff did not ensure resident was allowed to be readmitted to facility

INVESTIGATION FINDINGS:

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*** this report supersedes report dated 6/17/25 reason is to include additional information. There are no changes to the findings, which remain unsubstantiated ***

Licensing Program Analyst (LPA) Tena Herrera conducted a subsequent visit to investigate the above allegations. LPA met with Karen Meacham and discussed the purpose of today's visit.

The investigation consisted of the following:
LPA obtained copies of staff/resident rosters, copies of R1's Discharge Summary dated 7/15/25 and R1's facesheet, LPA interviewed 4 staff (S1-S4) and 11 residents (R2-R12). R1 was not able to be interviewed as they are no longer a resident at the facility, LPA was able to interview R1's responsible party during visit via telephone call.
(Continued on LIC9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Tena Herrera
LICENSING EVALUATOR SIGNATURE:	DATE: 10/06/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2025

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-20250613111812

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: 10/06/2025

NARRATIVE

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The investigation revealed the following:
Allegation: Staff did not ensure resident was allowed to be readmitted to facility.
It is alleged that staff are refusing to readmit R1 after hospitalization, claiming that they cannot provide care for R1. LPA interviewed 4 staff and each denied the above allegation. Interviews with S1 and S4 revealed that R1 was having a lot of difficulties at the facility, including being verbally aggressive towards staff and other residents and throwing objects in their room. S1 and S4 also stated that R1’s condition had progressed into treatment that facility could not provide and R1 needed a higher level of care, staff also stated that R1’s son was very involved in the relocation of R1 and was the induvial (along with R1) who decided to discharge R1 from facility. LPA soke with R1’s responsible party via telephone and they stated that R1 was in need of a higher level of care and this was understood and agreed with the facility staff and family, and that R1 was not refused readmittance it was due to a change of condition and a need of increased care. LPA interviewed 11 residents and each denied the alliteration, 8 of the 11 residents stated that they have been hospitalized and never had any issues returning to the facility post hospitalization.

Based on statements and interviews conducted with staff/residents, 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 emailed.

SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Tena Herrera
LICENSING EVALUATOR SIGNATURE:	DATE: 10/06/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2025

LIC9099 (FAS) - (06/04)

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