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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603710
Report Date: 06/04/2026
Date Signed: 06/04/2026 11:23:38 AM

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
04/01/2026 and conducted by Evaluator Daniel Konishi
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20260401120121
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: 94DATE:
06/04/2026
UNANNOUNCEDTIME BEGAN:
09:07 AM
MET WITH:Laura Sanchez, Health Services DirectorTIME COMPLETED:
11:25 AM
ALLEGATION(S):
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Facility staff abandoned resident at the hospital
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Daniel Konishi conducted a unannounced subsequent complaint visit in response to the above-mentioned allegation. LPA met with the Health Services Director, Laura Sanchez, and explained the reason for the visit.

On 4/07/2026, the initial investigation visit was conducted. The investigation consisted of the following:

LPA requested a copy of staff and resident rosters. LPA also requested copies from Resident#1 (R1’s) file such as the Face Sheet, Physician’s Report, Resident Assessment, and other pertinent documents. LPA interviewed the Staff #1 (S1) to Staff #5 (S5), and Resident #2 (R2) to Resident #9 (R9). LPA attempted to interview Resident #1 (R1) over the phone but LPA was unable to interview R1 since R1 did not answer any questions. LPA interviewed Witness #1 (W1) over the phone.

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Daniel Konishi
LICENSING EVALUATOR SIGNATURE:

DATE: 06/04/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/04/2026
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 3
Control Number 28-AS-20260401120121
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: 06/04/2026
NARRATIVE
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On 4/7/2026, LPA interviewed Staff #6 (S6).

On 6/3/2026, LPA contacted S1, S6 and W1 requesting documentation.

During today's visit, the investigation consisted of the following: LPA interviewed S1. LPA obtained pertinent documents.

The investigation revealed the following: in regard to the allegation, “Facility staff abandoned resident at the hospital” It is alleged that when R1 was ready to be discharged from the hospital, the facility would not take R1 back despite previously agreeing to do so. LPA attempted to interview R1 over the phone but LPA was unable to interview R1 since R1 did not answer any questions. R1 is no longer a resident of the facility as of 3/29/2026. LPA interviewed five (5) out of eight (8) residents that denied the allegation stating that when the resident was hospitalized and to be discharged from the hospital, the staff does not abandon the resident as they ensure that the resident are able to return back to the facility. LPA interviewed three (3) out of eight (8) residents stated that they have not been hospitalized during their stay at the facility. However, those three (3) out of eight (8) residents stated that they have not heard about staff abandoning residents at the hospital. LPA interviewed two (2) out of six (6) staff that denied the allegation stating that R1 was not abandoned at the hospital as they stated that there were discrepancies with R1’s Physician’s Report that the hospital physician filled out 3/27/2026 which did not include R1’s medication list and MRSA diagnosis which is a prohibited condition as it is a serious infection that is easily transmittable. S1 and W1 stated that R1 was admitted to the hospital on 3/20/2026. Per W1, R1’s MRSA isolation was cleared on 4/2/2026 which exceeded R1’s 14-day respite stay at the facility. Per W1 and one (1) staff, there was never an updated physician’s report completed by facility or hospital staff. Four (4) out of six (6) staff interviewed all stated they are not involved in R1’s matter being at the hospital. However, the four (4) out of six (6) staff indicated that they have not experienced any residents abandoned at the hospital while they have worked at the facility. S1 also stated that the facility did not refuse to accept R1 back to the facility since R1 was a resident on a respite stay for 14 days which R1 signed on 03/16/2026 and expired on 03/29/2026. Per interview with two (2) staff and record review, R1 did not pay for the respite stay as payment is provided prior to the respite stay and no payment was received from R1 during or after R1’s respite stay. There is not enough evidence to substantiate.
SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Daniel Konishi
LICENSING EVALUATOR SIGNATURE:

DATE: 06/04/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/04/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 28-AS-20260401120121
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: 06/04/2026
NARRATIVE
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Based on statements and interviews conducted with staff, residents, review of resident files and facility file records, there was not enough supportive evidence to concur with the reported allegation. 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 allegations are UNSUBSTANTIATED.

Exit interview was held, and a copy of this report was provided to the Health Services Director, Laura Sanchez.
SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Daniel Konishi
LICENSING EVALUATOR SIGNATURE:

DATE: 06/04/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/04/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 3