198603710-8-21-2025-28-AS-WSHO-DT8P7C-20260417110341

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603710
Report Date: 08/21/2025
Date Signed: 08/21/2025 01:48:54 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
08/18/2025 and conducted by Evaluator Mayra Cota

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20250818083342

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: 81	DATE:	08/21/2025
		UNANNOUNCED	TIME BEGAN:	08:47 AM
MET WITH:	Stephanie Guerrero, Wellness Nurse		TIME COMPLETED:	02:10 PM

ALLEGATION(S):

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Licensee does not ensure that facility is kept in good repair.
Staff do not ensure that residents' rooms are maintained in a sanitary condition.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA), Mayra Cota, conducted a 10-day complaint visit to investigate the above-mentioned allegations. LPA met with Stephanie Guerrero, Wellness Nurse and the reason for the visit was explained. Laura Sanchez, Director, was contacted via phone call and the reason for the visit was also explained. Stephanie Guerrero facilitated today’s visit and Laura Sanchez arrived thereafter.

The investigation consisted of the following:

During today’s visit, LPA obtained copies of staff/resident rosters and laundry schedules, toured the physical plant with a focus on observing the kitchen, dining and activity rooms, (3) facility laundry rooms and (2) soiled linen closets. LPA also inspected (10) resident rooms and conducted interviews with Staff 1 – Staff 8 (S1-S8) and Resident 1 – Resident 6 (R1-R6).

***Continues on LIC 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Mayra Cota
LICENSING EVALUATOR SIGNATURE:	DATE: 08/21/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2025

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 1 of 3

Control Number 28-AS-20250818083342

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: 08/21/2025

NARRATIVE

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The investigation revealed the following:

Regarding: Licensee does not ensure that facility is kept in good repair.

It is alleged that there is a water leak in the kitchen ceiling and that the facility’s plumbing is in disrepair.

During interviews, (5) staff denied the allegation. Five (5) interviewed staff indicated that the facility does not have a water leak in the kitchen nor anywhere else in the facility. S1-S3 stated that several weeks ago, the facility had water dripping from the dining and activity room ceiling in the Memory Care section of the building due to condensation building up in the drain pan of the air conditioning unit. However, interview with Plant Operations Director (S3) indicated, leak has been resolved. S3 stated, air conditioning unit was set at a lower temperature than usual and consequently, made the unit accumulate a high quantity of condensation which dripped from the drip pan and on to the ceiling tiles and floor in the dining and activity rooms. S3 stated, condensation accumulation is more common in times of high heat because the AC unit works harder to maintain a cool temperature. S3 further stated, “The water leak from the ceiling had nothing to do with the facility’s plumbing.” S3 indicated, in this facility, plumbing is nested along the inside of the walls and under the flooring and plumbing does not run above the ceiling. S1- S3 stated, no plumbing issues have been observed or reported. S1-S6 further indicated, they have not observed any more water leaking from the ceiling in the dining and activity rooms nor anywhere else in the facility. Interviews with (6) out of (6) residents have no concerns regarding water leaks. During LPA inspection of the physical plant, no water leaks were observed. Staff and resident interviews, and LPA observations do not corroborate the allegation.

Regarding: Staff do not ensure that residents' rooms are maintained in a sanitary condition.

It is alleged that blood, vomit and feces soaked garments are frequently placed in residents’ dirty clothes baskets which remain there for (7) days or more.

During the visit, (8) out of (8) staff interviewed deny the allegation. Staff interviewed indicated that heavily soiled bedding, towels and clothing which may contain vomit, feces or blood, are never mixed with residents’ mildly soiled articles which are placed in their laundry baskets in their room. Staff further indicated, if linen or clothing become heavily soiled, items are removed immediately out of residents’ rooms and placed in bags and tied up to prevent fluids from transferring onto other surfaces.

***Continues on LIC 9099-C page 2

SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Mayra Cota
LICENSING EVALUATOR SIGNATURE:	DATE: 08/21/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2025

LIC9099 (FAS) - (06/04)

Page: 3 of 3

Control Number 28-AS-20250818083342

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: 08/21/2025

NARRATIVE

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The bags are stored temporarily in the (2) soiled linen closets from which caregivers and housekeeping staff collect to wash. Bags collected are never kept for more than 24 hours before they are washed. Staff further stated, the facility has a laundry schedule for the AM, PM and NOC shifts which are followed to ensure residents’ linen and clothes are washed in a timely manner. Six (6) staff indicated, the facility has three laundry rooms equipped with commercial and industrial grade washers and dryers which accommodate large quantities of soiled items. Staff further indicated, laundry hampers in resident rooms are always monitored by caregivers and housekeeping staff and “emergency washes” are conducted in between scheduled laundry times particularly for items which should not remain in residents’ rooms to prevent contamination and odors from transferring. During the inspection of 10 resident rooms, no blood, vomit and feces soaked garments were observed in resident laundry baskets nor anywhere else in their room. Interviews with (6) out of (6) residents indicated their clothing gets washed in a timely manner and they have no concerns with clothes or linen not being collected or properly removed from their room to be washed. Review of laundry schedule indicated washing is conducted daily for every shift. At the time of visit, LPA observed laundry attendants washing clothes and linen. Staff and resident interviews, observation and record review, do not corroborate the allegation.

Although the allegations may have happened or are valid, there is no preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are unsubstantiated. An exit interview was conducted with Stephanie Guerrero, Wellness Nurse, and a copy of this report was provided.

SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Mayra Cota
LICENSING EVALUATOR SIGNATURE:	DATE: 08/21/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2025

LIC9099 (FAS) - (06/04)

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