331881086-12-30-2022-18-AS-JDHS-D77VLU-20240715163232

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331881086
Report Date: 12/30/2022
Date Signed: 12/30/2022 03:32:03 PM

Unfounded

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/29/2022 and conducted by Evaluator Stephanie Torres

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20221229100319

FACILITY NAME:	BAYSHIRE RANCHO MIRAGE		FACILITY NUMBER:	331881086
ADMINISTRATOR:	KIRBY, SCOTT		FACILITY TYPE:	741
ADDRESS:	72201 COUNTRY CLUB DRIVE		TELEPHONE:	(760) 340-5999
CITY:	RANCHO MIRAGE	STATE: CA	ZIP CODE:	92270
CAPACITY:	135	CENSUS: 103	DATE:	12/30/2022
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Brittany Holm, Executive Director		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Staff do not assist resident with getting out of bed

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA), Stephanie Torres, conducted an unannounced visit to the facility to initiate the investigation into the above allegations. The LPA met with Executive Director (ED), Brittany Holm, and informed her of the purpose of the visit. The LPA conducted staff/resident interviews, reviewed records, and took copies of pertinent documentation. Regarding the allegation, "Staff do not assist resident with getting out of bed," it was alleged facility staff are not assisting Resident One (R1) to get out of bed due to direction given by a family member. ED Holm was interviewed and reported she had no knowledge of the allegation. Staff interviews reported R1 has remained in bed recently, due to direction given from several sources, including a family member and a company contracted to provide specialized care to the resident. Interviews provided different information; some reported R1 has not directly requested staff assistance while another stated R1 has requested assistance. Interviews revealed R1 has come out of their bedroom for meals. R1 was interviewed and denied the allegation. Therefore, based on interviews, this allegation is deemed UNFOUNDED. A finding that the complaint is unfounded means the allegation is false, could not have happened, and/or is without a reasonable basis. This report was reviewed with ED Holm and a copy was provided.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Deborah Mullen	TELEPHONE: (951) 248-0313
LICENSING EVALUATOR NAME: Stephanie Torres	TELEPHONE: (951) 204-5924
LICENSING EVALUATOR SIGNATURE:	DATE: 12/30/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/30/2022

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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