198603710-8-26-2024-28-AS-RORN-D8ZQD9-20240911120423

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603710
Report Date: 08/26/2024
Date Signed: 08/26/2024 04:38:15 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
08/19/2024 and conducted by Evaluator Bonnie Tao

COMPLAINT CONTROL NUMBER: 28-AS-20240819084930

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: 55	DATE:	08/26/2024
		UNANNOUNCED	TIME BEGAN:	08:00 AM
MET WITH:	Laura Sanchez, health service director		TIME COMPLETED:	04:30 PM

ALLEGATION(S):

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Facility is in disrepair.
Facility does not ensure equipment is properly maintained.
Facility staff are not trained in the operation of the Hoyer lift.
Staff does not have appropriate qualifications.
Facility forced resident to change hospice companies against resident’s will.
Staff did not meet resident’s care needs in a timely manner.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Tao conducted an unannounced complaint investigation for the allegations listed above. LPA met Laura Sanchez, health service director and explained the purpose of today's complaint investigation visit.

The investigation consisted of the following: obtained staff / resident roster and resident#1’s (R1) records; interviewed residents from resident#1 (R1) to resident#4 (R4); interviewed staff from staff#1 (S1) to staff#4 (S4); and conducted a physical plant.

The investigation revealed the following:
In regard of allegation that the facility is in disrepair, it was alleged that the facility's air conditioner (AC) is leaking. LPA interviewed residents and all four (4) out of four (4) residents could not corroborate the allegation. Residents’ interview revealed the facility AC is not leaking and working.
(-continued in LIC9099C-)

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Bonnie Tao
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 08/26/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2024

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-20240819084930

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: 08/26/2024

NARRATIVE

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All four (4) staff interviewed denied the allegation. Staff interviews revealed the facility AC is not leaking. LPA conducted a physical plant and observed the AC is working and not leaking. Thus, the facility’ AC is not in disrepair.

In regard of allegation that the facility does not ensure equipment is properly maintained, it was alleged that the facility Hoyer lifts are outdated and not maintained. LPA interviewed residents, all four (4) out of four (4) residents could not corroborate the allegation. Residents’ interviews revealed that the facility Hoyer lifts were working properly and maintained by either hospice or home health agencies. All four (4) staff interviewed denied the allegation. Staff stated facility Hoyer lifts were operational and maintained. LPA observed staff operating the Hoyer lifts and they were working appropriately. Thus, the facility had maintained equipment and worked properly.

In regard of allegation that the facility staff are not trained in the operation of the Hoyer lift, it was alleged that the facility staff are not trained to use the Hoyer lifts. LPA interviewed residents, all four (4) out of four (4) residents could not corroborate the allegation. Residents’ interviews revealed that the facility staff were able to use Hoyer lifts when providing cares. All four (4) staff interviewed denied the allegation. Staff stated facility had provided training to staff on how the operate Hoyer lifts properly. As mentioned above, LPA observed staff operating the Hoyer lifts and they were handling / working the Hoyer lifts appropriately. Thus, the facility staff were able to operate the Hoyer lifts.

In regard of allegation that staff does not have appropriate qualifications, it was alleged that the facility’s acting Administrator is not qualified while the administrator was absent. LPA interviewed residents, all four (4) out of four (4) residents could not corroborate the allegation. Residents’ interviews revealed that the facility’s acting administrator was able to provide cares to residents as needed. All four (4) staff interviewed denied the allegation. Staff stated the acting administrator was able to perform the acting administrator’s job descriptions and provided guidance to staff. LPA reviewed staff records and current administrator certificates were observed. Thus, the facility staff have appropriate qualifications. (-continued in LIC9099C-)

NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Bonnie Tao
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 08/26/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 28-AS-20240819084930

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: 08/26/2024

NARRATIVE

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In regard of allegation that facility forced resident to change hospice companies against resident’s will, it was alleged that a resident was allegedly forced to change hospice companies against resident’s will. LPA interviewed residents, all four (4) out of four (4) residents could not corroborate the allegation. LPA interviewed the claimed resident who was forced to change hospice agencies. Resident’s interviews revealed that resident was aware of the changes and was not forced to change. Changes of hospice cares were due to the resident’s care needs and resident’s own wish. All four (4) staff interviewed denied the allegation. Staff stated staff would not force residents to choose their hospice agencies. Thus, the facility staff did not force residents to change hospice companies.

In regard of allegation that staff did not meet resident’s care needs in a timely manner, it was alleged that that staff takes long time to respond to resident’s calls. LPA interviewed residents all four (4) out of four (4) residents could not corroborate the allegation. Resident’s interviews revealed that it usually took 10-15 minutes for staff to respond to resident’s calls and it was acceptable to residents. All four (4) staff interviewed denied the allegation. Staff stated they would response to resident’s calls as soon as they received them. Facility staff may assist with other residents while other residents called for assistance at the same time, staff would assist the new call as soon as they finished assisted other residents. LPA tested the call buttons during the physical plant, it took about 5-10 minutes to have a staff arrived at the rooms to assist residents. Thus, the facility staff did not fail to provide care to residents in a timely manner.

Based on the information obtained during the investigation, interviews with staff, residents, review of resident files and LPA's observation, the investigation did not reveal any evidence to support the allegations mentioned above.

Although the allegations may have happened or are valid, there is not preponderance of evidence to prove the alleged violations did or did not occur, therefore, the allegations are UNSUBSTANTIATED.

An exit interview was conducted with Laura Sanchez, health service director and findings were discussed. A copy this report was provided at time of visit.

NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Bonnie Tao
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 08/26/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2024

LIC9099 (FAS) - (06/04)

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