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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603710
Report Date: 02/11/2025
Date Signed: 02/11/2025 04:03:06 PM

Document Has Been Signed on 02/11/2025 04:03 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:BAYSHIRE SAN DIMASFACILITY NUMBER:
198603710
ADMINISTRATOR/
DIRECTOR:		COLEMAN, CHADFACILITY TYPE:
741
ADDRESS:1740 S SAN DIMASTELEPHONE:
(909) 394-0304
CITY:SAN DIMASSTATE: CAZIP CODE:
91773
CAPACITY: 119CENSUS: 70DATE:
02/11/2025
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:22 AM
MET WITH:Health Services Director, Laura SanchezTIME VISIT/
INSPECTION COMPLETED:
02:20 PM
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Program Analyst (LPA) Vaid made an unannounced visit to the facility to conduct a Case Management visit to evaluate the resident’s displacement by the Eaton Fire. LPA met with Health Service Director Laura Sanchez, and explained the purpose for the visit.

There are currently seven (7) residents who were relocated from a facility in Altadena (MONTECEDRO 197610430) on 01/09/2025.

LPA Vaid observed, and interviewed four (4) displaced residents. Three (3) residents were not available for interview. All residents interviewed feel safe and comfortable at the Bayshire facility but are anxious to return home to Montecedro. Residents interviewed stated, they are receiving good care, food is good, medications are administered timely as per physicians orders.

Displaced residents interviewed reside in rooms:
155, 213, 214, 234. Residents room are clean and have bed, table, reading lamp, chair and linens.
The water temperature was checked is between 105-120* F, within regulations.

Residents are receiving the care and supervision they need. No health and safety concerns observed during the tour of the facility.

Exit interview conducted and copy of this report was left with Health Services Director, Laura Sanchez.
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Sanjay Vaid
LICENSING EVALUATOR SIGNATURE: DATE: 02/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/11/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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