331881086-8-19-2024-18-AS-TDAN-D8KPWF-20240828114039

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331881086
Report Date: 08/19/2024
Date Signed: 08/19/2024 02:15:19 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 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
03/15/2022 and conducted by Evaluator Sara Martinez

COMPLAINT CONTROL NUMBER: 18-AS-20220315104748

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: 114	DATE:	08/19/2024
		UNANNOUNCED	TIME BEGAN:	09:35 AM
MET WITH:	Jimmy Stewart - Executive Director		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Staff failed to meet resident's medical needs
Staff neglected resident while in care
Staff failed to respond to residents' call assistance buttons in a timely manner
Staff failed to meet resident's needs

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Sara Martinez arrived unannounced to the facility to conclude the investigation into the allegation listed above. LPA met with Executive Director Jimmy Stewart and explained the purpose of the visit. LPA’s complaint investigation consisted of a tour of the interior/exterior areas of the facility, observations, interviews with staff and residents, and records review of requested pertinent documents.

Regarding the allegation “Staff failed to meet resident's medical needs”, Record review of R1’s “Resident Assessment” dated 06/10/2021 reveals R1 was scored on a Level 1 care and was independent, ambulatory, required no assistance with activities of daily living (ADL), and had the capabilities to administer their own medication. Interview with eight (8) residents reported staff would contact emergency services to send to the hospital when needed based on previous experiences or speculation. Interview with six (6) staff members deny ignoring residents’ medical needs and would contact primary physician or emergency services if there was a change in condition. Interview with R1 could not be conducted due to resident’s passing in March 2022.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Tricia Danielson	TELEPHONE: (951) 202-5067
LICENSING EVALUATOR NAME: Sara Martinez	TELEPHONE: (951) 605-0913
LICENSING EVALUATOR SIGNATURE:	DATE: 08/19/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2024

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 18-AS-20220315104748

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: BAYSHIRE RANCHO MIRAGE	FACILITY NUMBER: 331881086
	VISIT DATE: 08/19/2024

NARRATIVE

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Regarding the allegation “Staff neglected resident while in care”, it was reported staff was neglecting R1 and did not meet R1’s needs. Record review of R1’s “Resident Assessment” dated 06/10/2021 reveals R1 was scored on a Level 1 care and was independent, ambulatory, required no assistance with activities of daily living (ADL), and had the capabilities to administer their own medication. Interview with eight (8) out of nine (9) residents deny staff neglecting residents in care and would assist residents when necessary. Interview with six (6) out of (six) staff reported they would assist residents when requested and never witnessed staff neglecting residents in care.

Regarding the allegation “Staff failed to respond to residents' call assistance buttons in a timely manner” it was reported staff do not respond to residents’ call button request. Interview with nine (9) out of (9) residents revealed staff respond to residents’ call button request in an adequate amount of time. Interview with five (5) out of six (6) staff revealed staff respond to residents’ call button request as soon as they can and staff response time varies but staff will respond to call button request and assist residents. Investigation did not reveal documents to corroborate nor refute call time responses due to call logs not being available for review.

Regarding the allegation “Staff failed to meet resident's needs”, it was reported when R1 returned from the hospital staff were not able to R1’s needs. R1 returned to the facility on 02/21/2022 and had Resident Assessment set at Level 4 care. Level 4 care for R1 reflected direct supervision of R1 and one to two person total assistance with bathing, dressing , grooming, toileting, and ambulation. R1’s Physician’s Report dated 02/22/2022 revealed R1 needed assistance with ADLs, was non-ambulatory, and was not able to administer own medication. Interview with three (3) staff who worked at the facility in 2022 denied not being able to meet the residents needs and corroborated that Level 4 care included direct supervision of the resident and two hour safety checks. Interview with eight (8) residents deny staff failing to meet their needs.

Although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated. An exit interview was conducted, and a copy of this report was provided to Executive Director Stewart.

SUPERVISOR'S NAME: Tricia Danielson	TELEPHONE: (951) 202-5067
LICENSING EVALUATOR NAME: Sara Martinez	TELEPHONE: (951) 605-0913
LICENSING EVALUATOR SIGNATURE:	DATE: 08/19/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2024

LIC9099 (FAS) - (06/04)

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