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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 191500609
Report Date: 10/06/2025
Date Signed: 10/06/2025 04:04:08 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
02/20/2025 and conducted by Evaluator Tena Herrera
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20250220160903
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: 116DATE:
10/06/2025
UNANNOUNCEDTIME BEGAN:
09:17 AM
MET WITH:Karen Meacham – AdministratorTIME COMPLETED:
04:20 PM
ALLEGATION(S):
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Staff did not provide resident transportation to medical appointments
Staff tampered with residents’ mail
Staff were harassing resident
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, toured facilities mail area and inspected mail, reviewed facilites transportation log and obtained copies of the log from May-October 2025, interviewed 4 Staff (S1-S4) and 11 residents (R2-R12), R1 was not able to interviewed as they are no longer a resident at the facility and LPA was not able to reach R1 through several phone call attempts.
(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-20250220160903
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 provide resident transportation to medical appointments
It is alleged that R1 has missed doctors’ appointments due to facility not providing transportation. LPA interviewed 4 staff and each denied the above allegation. Interview with S2 revealed that residents prefer using the facility van, however, if they do not schedule their transportation in a timely manner there may be situations where the slots are full. S2 stated if the slots for transportation are full, the residents are also offered other sources of transportation such as access/dial a ride/uber. LPA interviewed 11 residents and each resident denied the above allegation and stated they haven’t had any issues with getting transportation, interviews revealed that although sometimes the appointments for rides with the facility van are booked they are offered other sources of transportation or use the transportation service provided through their insurance. Allegation: Staff tampered with residents’ mail
It is alleged that R1’s mail had been opened with envelopes taped together, and S2 stated the mail was opened by accident. LPA toured mail area, observed mail in mail boxes and did not see any mail that appeared to be tampered with or opened, each envelope appeared well sealed and unopened. LPA interviewed 4 staff and each denied the above allegation, interviews revealed that the receptionist is who sorts through the mail and will sort the mail by placing the residents number on it and then distributing the mail in proper slots, staff each stated they have never tampered with the mail or observed a staff doing this. LPA interviewed 11 residents and each resident denied the allegation and stated they have never observed their mail to look tampered with.
Allegation: Staff were harassing resident
It is alleged that S2 and S5 are making false accusations towards R1 which is causing R1 distress. LPA interviewed 4 staff and each staff denied the above allegation, interviews with S1, S2 and S4 revealed that R1’s room once had the fire sprinkler go off and through investigation questions such as: were you smoking? Did something burn?, were being asked and they believe this is where R1 felt accused but these were just questions that need to be asked for the investigation not to accuse R1 or to make them feel harassed. LPA interviewed 11 residents, and each denied the allegation and stated staff have never made them feel harassed or accused of things.

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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