198603710-2-13-2026-28-AS-FFIS-DSBVBW-20260319161814

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603710
Report Date: 02/13/2026
Date Signed: 02/13/2026 03:09:12 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 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: 85	DATE:	02/13/2026
		UNANNOUNCED	TIME BEGAN:	02:29 PM
MET WITH:	LVN- Stephanie Guerreo		TIME COMPLETED:	03:00 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Program Analyst (LPA) Kimberly Ramirez conducted an unannounced subsequent complaint visit on 02/17/2026, to deliver a superseded report regarding the above allegation to provide additional and clarifying information not included on report dated 02/07/2026. The finding will remain the same. LPA 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).

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Kimberly Ramirez
LICENSING EVALUATOR SIGNATURE:	DATE: 02/13/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2026

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-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: 02/13/2026

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 wound care to residents. Five (5) out of the five (5) staff interviewed denied this allegation. Four (4) out of the four (4) residents interviewed did not corroborate this allegation. Review of staff rosters revealed that two staff members have the same first name but hold different titles. Records reviewed revealed that S1 is a Licensed Vocational Nurse and S5 is a Medication Technician. 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 has received training on medication administration and other topics associated to their position. Interview with S2 revealed that S1 is qualified to provide wound care. During record review, LPA Ramirez observed S1’s valid Licensed Vocational Nurse license and S5’s recent Medication Technician training. Review of R1-R4 resident files revealed that they receive wound care from an outside agency and these outside agencies document the care provided. 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: 02/13/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2026

LIC9099 (FAS) - (06/04)

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