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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603710
Report Date: 08/13/2024
Date Signed: 08/13/2024 02:54:54 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
08/05/2024 and conducted by Evaluator Mary G Flores
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20240805164945
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:
08/13/2024
UNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Laura Sanchez - Health Services CoordinatorTIME COMPLETED:
03:10 PM
ALLEGATION(S):
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Licensee is not ensuring that the personal property of resident(s) in care is being safeguarded.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Mary Flores conducted an unannounced complaint investigation visit regarding the above allegation. LPA met Laura Sanchez with and explained the reason for the visit.

The investigation consisted of the following: LPA requested a copy of staff/resident roster. LPA reviewed interviewed 6 residents and 5 staff. LPA requested a copy of resident’s #1(R1) physician’s report, needs and care plan, and preplacement appraisal, and identification and emergency information.

The investigation revealed the following: Regarding allegation: Licensee is not ensuring that the personal property of resident(s) in care is being safeguarded. It is alleged money has been stolen from residents’ rooms. Interviews conducted with residents revealed 5 out of 6 residents interview stated their personal belongings have not gone missing, and they feel comfortable that items will not be missing from their rooms, 1 out of 5 residents stated to have not been able to find money that was left on dresser overnight on one occasion. (CONTINUED ON LIC 9099C)
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Mary G Flores
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2024
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-20240805164945
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: 08/13/2024
NARRATIVE
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Interviews with staff revealed 3 out of 5 staff stated to not been aware of residents reporting any items missing, and staff usually assist when a resident leaves their personal belongings around. Administrator and health service coordinator stated that they had one resident report that money had gone missing, and they assisted the resident to look for the money, staff found money. However, the resident stated that was not the money that was missing. There have not been other reports of money missing from other residents in the last four months. Documents review revealed R1 is independent. Although the allegation may have happened there is not enough evidence that the money was stolen from the resident's room at this time.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Exit interview was conducted with Lisa Gomez and a copy of this report was provided.
NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Mary G Flores
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2024
LIC9099 (FAS) - (06/04)
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