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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603710
Report Date: 05/30/2024
Date Signed: 05/30/2024 01:22:03 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
05/23/2024 and conducted by Evaluator Jewel Baptiste
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20240523091436
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: 53DATE:
05/30/2024
UNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Manager Lisa Gomez TIME COMPLETED:
01:36 PM
ALLEGATION(S):
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Staff was under the influence while on shift
Staff yelled at residents in care
INVESTIGATION FINDINGS:
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On 5/30/2024 at 9:15 a.m., Licensing Program Analyst (LPA) Baptiste made an unannounced complaint visit to the facility to investigate the allegations listed above. LPA Baptiste met with the Manager, Lisa Gomez, and explained the purpose for the visit.

During the visit today, LPA obtained a copy of staff roster and client roster. LPA Baptiste toured the facility with Plant Ops Director and reviewed facility files for the Manager and Staff #1(S1). LPA Baptiste also interviewed the Manager and a total of three (3) staff, whom shall be known as Staff #1 through Staff #3. LPA also interviewed a total of six (6) residents, whom shall be referred to as Resident#1 through Resident# 6. LPA attempted to interview Resident #7, but they declined to be interview.
(Report continued on LIC9099-C...)
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Jewel Baptiste
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/30/2024
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-20240523091436
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: 05/30/2024
NARRATIVE
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The investigation reveals the following: Regarding “Staff was under the influence while on shift”. It was alleged that staff came to work under the influence of alcohol and drugs. The Manager denied the allegation and expressed that staff do not come to work under the influence nor do they smell of drugs and alcohol. 3 out 3 staff denied the allegation stating they have never came to work under the influence or witness other staff coming to work under the influence. 6 out of 6 residents denied the allegation stating they have not witness staff influence of drugs or alcohol at the facility.

The investigation reveals the following: Regarding “Staff yelled at residents in care”. It was alleged staff yelled at the residents in care. The manager denied the allegation, stating staff has never yelled at the residents and none of the residents complained about being mistreated. 3 out of 3 staff denied the allegation stating they have never yelled at the residents and have never witness other staff members yelling at the residents. 5 out 6 residents denied the allegation stating the staff treat them well. 1 out of 6 residents stated one (1) caregiver handles them roughly.

Based on LPA's interviews, investigation revealed: 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 conducted with Manager Lisa Gomez and a copy of this record provided.
NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Jewel Baptiste
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/30/2024
LIC9099 (FAS) - (06/04)
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