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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603710
Report Date: 08/04/2025
Date Signed: 08/04/2025 02:17:26 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 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
07/28/2025 and conducted by Evaluator Mary G Flores
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20250728094323
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: 80DATE:
08/04/2025
UNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Genesis Rivas - Receptionist TIME COMPLETED:
02:30 PM
ALLEGATION(S):
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Facility staff is not allowing residents to select their own hospice agency
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Mary Flores conducted an unannounced complaint investigation visit regarding the above allegation. LPA met with Genesis Rivas and Nadia Batista Human Resources and explained the reason for the visit. Wellness Director arrived at 9:30am.

The investigation consisted of the following: LPA requested staff/resident roster. LPA interviewed 8 residents, 6 staff, and reviewed files for 6 residents. Requested copies of Identification and Emergency sheet, Physician’s Report, and Hospice plan for 6 residents. LPA contacted 6 residents’ responsible parties over the phone. LPA requested Death reports within the last three months.

The investigation revealed the following: Regarding allegation: Facility staff is not allowing residents to select their own hospice agency. It is alleged facility staff forces responsible parties/residents to choose a specific hospice agency which does not provide proper care.
(CONTINUED ON LIC 9099C)
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Mary G Flores
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2025
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-20250728094323
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		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 DIMAS
FACILITY NUMBER: 198603710
VISIT DATE: 08/04/2025
NARRATIVE
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Interviews with residents revealed 3 out of 8 residents interviewed were not aware with process as their responsible party assisted with choosing a hospice agency. 3 out of 8 residents were unable to be interviewed due to cognitive skills. 2 out of 8 residents stated they did not know they had a choice in picking the hospice service agency. Interviews conducted with staff revealed some residents are admitted to the facility with their hospice agency in place. However, when the residents residing are assessed and need to obtain hospice care, the Health - Wellness Director meets with the responsible party and provides recommendations of different hospice agencies from which responsible parties or residents choose. Three of the responsible parties interviewed belief there was only one hospice service agency and were not aware there were other hospice agencies to choose from. One of the responsible parties interviewed stated they were aware they had different choices for hospice care. Documents reviewed revealed there are 27 residents currently in hospice and 8 different hospice agencies providing services to residents in care. A total of 7 death reports were reviewed, 4 different hospice agencies were noted providing care at the time of death for the seven residents.

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 Laura Sanchez Health-Wellness Director and a copy of this report was provided.
NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Mary G Flores
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2025
LIC9099 (FAS) - (06/04)
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