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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603710
Report Date: 04/11/2024
Date Signed: 04/11/2024 01:44:00 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
04/03/2024 and conducted by Evaluator Nune Margaryan
COMPLAINT CONTROL NUMBER: 28-AS-20240403151615
FACILITY NAME:BAYSHIRE SAN DIMASFACILITY NUMBER:
198603710
ADMINISTRATOR:COLEMAN, CHADFACILITY TYPE:
741
ADDRESS:1740 S SAN DIMASTELEPHONE:
(909) 394-0304
CITY:SAN DIMASSTATE: CAZIP CODE:
91773
CAPACITY:119CENSUS: 57DATE:
04/11/2024
UNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Heather O'NeelTIME COMPLETED:
01:30 PM
ALLEGATION(S):
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Staff do ensure the facility's communication devices are properly operating.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Nune Margaryan conducted an unannounced 10 day complaint visit to this facility. Upon arriving at the facility, LPA met with Heather O'Neel HSD (Health Services Director) who assisted with the visit. LPA explained the purpose of today’s visit.

During today's visit, LPA obtained a copy of the staff and resident rosters, work note from Facility Operational Analyst / IT, interviewed Heather O'Neel - HSD, Staff #1 - Staff #5 (S#1 - S#5), Facility Operation Analyst / IT and Resident#1 - Resident#6 (R#1 - R#6). The Facility Operation Analyst / IT was intervewed over the phone. LPA also toured a random selection of resident rooms on each floor with the assistance of the HSD.

Continue 9099C
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Nune Margaryan
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2024
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-20240403151615
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: BAYSHIRE SAN DIMAS
FACILITY NUMBER: 198603710
VISIT DATE: 04/11/2024
NARRATIVE
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Allegation: Staff do ensure the facility's communication devices are properly operating. It was alleged that during the last weekend of March and thru the April first there was no internet at the facility and communication systems have stopped, including individual resident pendants each resident carries to call / page for assistance. It was reported that residents could not call for and get assistance.

Interviewed HSD stated that on April 1st, 2024, Bayshire took over ownership of the building / facility. During that transition they replaced all the internet / Wi-Fi access points and internet switches in the building. Work started April 1st in the morning, approximately from 7am.- 12 pm. During that time the pendant system was down. All interviewed staff stated that for residents safety, 30 minutes to 1 hour checks were done on every resident. All staff including Care staff, Med. Techs, RCC (Residents Care Coordinator) and nurses were involved in these checks. Interviewed IT confirmed that work done at the facility on April 1st, and it took about 4-5 hours. All interviewed residents stated that their pendants are working, and they can call for the assistance if they needed. During the visit LPA ask randomly chosen residents to push the pendant button and observed that residents pendants are operational, and the staff came in to check with residents in 2-3 minutes.

Based on the observations and interviewed conducted with staff and residents, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Exit interview held, and a copy of this report was provided to Heather O'Neel.

NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Nune Margaryan
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2024
LIC9099 (FAS) - (06/04)
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