198603710-7-2-2024-28-AS-DSIS-D74TWN-20240712150550

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603710
Report Date: 07/02/2024
Date Signed: 07/02/2024 01:13:55 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
06/25/2024 and conducted by Evaluator Bennette Pena

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20240625124331

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: 53	DATE:	07/02/2024
		UNANNOUNCED	TIME BEGAN:	09:55 AM
MET WITH:	Lisa Gomez - General Manager		TIME COMPLETED:	12:51 PM

ALLEGATION(S):

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Staff are preventing resident from receiving telephone calls.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Bennette Pena conducted an unannounced initial complaint visit to investigate the above allegation. LPA met with Lisa Gomez, General Manager and explained the purpose of the visit.
During today’s visit LPA toured the facility’s common areas, lobby, reception area, obtained resident & staff rosters and Staff #2 (S2)'s timecard. LPA interviewed Staff #1 (S1) – Staff #5 (S5), Resident #1 (R1) – Resident #6 (R6).
In regards to the allegation: “Staff are preventing resident from receiving telephone calls.” It is alleged that facility is never opened at 8am, front door is locked until 9am and calls were unanswered. (5) out of (5) interviewed staff denied the allegation. Interviewed staff stated that they are aware of the residents personal rights to have reasonable access to telephones, to both make and receive confidential calls. However, staff stated that residents in the Assisted Living unit have their own cell phones and do not have land lines set up in their rooms. Staff stated that the type of calls they receive are mostly for Skilled Nursing Facility (SNF) residents because they have telephones set up in their rooms.*****CONTINUED ON LIC9099-C*****

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Bennette Pena
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 07/02/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2024

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-20240625124331

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: 07/02/2024

NARRATIVE

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All interviewed staff stated that the Assisted Living's main telephone line is switched to night mode at 8pm. On night mode, all calls are automatically transferred to the SNF's nursing unit station where staff are available to answer calls. S4 also stated that she is the back up receptionist and comes in early. (1) out of (6) residents interviewed stated that she had seen the staff come in late and that the front door does not get opened until after 8am. (6) out of (6) residents interviewed stated that they are receiving calls through their cell phones and not transferred from the main line. All interviewed residents stated that they never had an issue with receiving or making calls. During today’s visit, LPA observed the residents carrying their cell phones and staff answering the incoming calls from the main line. LPA also observed (3) after hours phone numbers posted outside the main door. Therefore there was insufficient evidence to corroborate with this allegation.

Based on observations, statements and interviews conducted with residents and staff as well as reviewed files and documentation, there was not enough supportive evidence to corroborate the allegation.

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 Lisa Gomez, House Manager.

NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Bennette Pena
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 07/02/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2024

LIC9099 (FAS) - (06/04)

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