331881086-3-18-2026-18-AS-JDHS-DSKUVB-20260327155451

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331881086
Report Date: 03/18/2026
Date Signed: 03/18/2026 03:46:17 PM

Unfounded

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
03/11/2026 and conducted by Evaluator Armando Perez

COMPLAINT CONTROL NUMBER: 18-AS-20260311114143

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: 113	DATE:	03/18/2026
		UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Executive Director Jimmy Stewart		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Staff left resident unattended at an off-site location

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPAs), Armando Perez and Ivashia Wright, conducted an unannounced visit to deliver findings for a complaint investigation regarding the above allegation. LPA Perez met with Executive Director Jimmy Stewart, and explained both the purpose of the visit and the details of the allegation.

On March 11, 2026, the Community Care Licensing Division (CCLD) received a complaint alleging that facility staff left a resident unattended at an off-site location. It was reported that on March 11, Resident 1 (R1) arrived at what they believed was a scheduled medical appointment and was left without confirmation or supervision by facility staff.

An interview with the Additional Witness could not be conducted, as the report was submitted anonymously and no contact information was provided to obtain further information.

Continued on LIC 9099-C.

Unfounded

Estimated Days of Completion:

SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Armando Perez
LICENSING EVALUATOR SIGNATURE:	DATE: 03/18/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2026

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 18-AS-20260311114143

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: 03/18/2026

NARRATIVE

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Interview with Executive Director (ED) revealed the facility operates a transportation service daily on weekdays from 8:00 A.M. to 4:00 P.M. The ED explained that residents submit transportation requests through the concierge, and staff verify the address provided; however, staff do not question the purpose of the trip. ED confirmed they were informed of the incident with R1 and noted R1 independently scheduled the appointment which was not directed by staff.

Interview with R1 corroborated the ED’s statements. R1 reported that they independently searched for a dentist online and misunderstood the services being provided at the destination they requested. R1 also stated that the driver was contacted immediately after the error was realized and returned within approximately two to three minutes of drop-off. Interview with Staff 2 (S2) indicated that they dropped off R1 and waited until they visually confirmed R1 entered the building. S2 reported they had only just begun to drive away and were still in the parking lot when they received the call to return. S2 stated they acknowledged the request and returned R1 safely back to the facility.

A review of the transportation log confirmed that R1 independently requested off-site transport on March 11, including the date, time, and address. A review of medical documents, including the needs and services plan, noted that R1 is able to transfer safely with or without assistance. Additionally, the medical assessment indicates that R1 is permitted to leave the facility unsupervised. A review of the Admissions Record, R1 lists self as responsible party and is able to make their own decisions independently.

Based on interviews, research, and record review, the allegations staff left resident unattended at an off-site location is unfounded. A finding that the allegation is unfounded meaning that the allegation was false, could not have happened, and/or is without a reasonable basis. Therefore, this complaint is dismissed.

An exit interview was conducted. A copy of this report was provided to Executive Director Jimmy Stewart.

SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Armando Perez
LICENSING EVALUATOR SIGNATURE:	DATE: 03/18/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2026

LIC9099 (FAS) - (06/04)

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