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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603710
Report Date: 02/07/2026
Date Signed: 02/07/2026 01:34:47 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
01/05/2026 and conducted by Evaluator Kimberly Ramirez
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20260105100606
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: 85DATE:
02/07/2026
UNANNOUNCEDTIME BEGAN:
01:23 PM
MET WITH:LVN- Stephanie GuerreoTIME COMPLETED:
01:45 PM
ALLEGATION(S):
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Unqualified staff member is providing care to residents in care.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Kimberly Ramirez conducted an unannounced subsequent complaint visit on 02/07/2026, regarding the above allegation to deliver findings. On 01/08/2026, LPA Ramirez conducted an unannounced initial complaint investigation visit and a need further investigation was documented. During today’s visit, LPA Ramirez was greeted by LVN- Stephanie Guerreo and explained the purpose of the visit

The investigation consisted of the following: LPA Ramirez requested and obtained copies of Staff Roster, Resident Roster, copy of MedTech and licensed vocational nurse job descriptions/duties, copy of staff#1 (S1) and physical plant tour. LPA Ramirez conducted the following interviews: Staff#1 - 5 interviews (S1 – S5) and Resident#1-4 Interviews (R1- R4).

See 9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Kimberly Ramirez
LICENSING EVALUATOR SIGNATURE:

DATE: 02/07/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2026
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 2
Control Number 28-AS-20260105100606
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: 02/07/2026
NARRATIVE
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The investigation revealed the following: regarding the allegation “Unqualified staff member is providing care to residents in care.” It is alleged an unqualified staff member is providing care to residents. Five (5) out of the five (5) staff interviewed denied this allegation. Four (4) out of the four (4) residents interviewed denied this allegation. Resident interviews revealed that residents feel well cared for by staff and feel staff meet their care needs. Staff interviews revealed that S1 holds a current Licensed Vocational Nurse (LVN) license with an expiration 12/2027 and S5 completed training on according to their position. During record review, LPA Ramirez observed S1’s LVN license and S5’s recent training. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

No deficiencies were cited during this visit. Exit interview was conducted. A copy of this report was provided.

SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Kimberly Ramirez
LICENSING EVALUATOR SIGNATURE:

DATE: 02/07/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 2