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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331881086
Report Date: 08/27/2021
Date Signed: 08/27/2021 11:06:26 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:BAYSHIRE RANCHO MIRAGEFACILITY NUMBER:
331881086
ADMINISTRATOR:KIRBY, SCOTTFACILITY TYPE:
741
ADDRESS:72201 COUNTRY CLUB DRIVETELEPHONE:
(760) 340-5999
CITY:RANCHO MIRAGESTATE: CAZIP CODE:
92270
CAPACITY:135CENSUS: 76DATE:
08/27/2021
TYPE OF VISIT:Post LicensingUNANNOUNCEDTIME BEGAN:
09:39 AM
MET WITH:Roland GandyTIME COMPLETED:
11:10 AM
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Licensing Program Analyst (LPA) Anna Bueno arrived to the facility to conduct a post licensing inspection and to confirm the facility name is under the address 72201 Country Club Drive Rancho Mirage, 92270. The facility is licensed for 135 non-ambulatory with a hospice waiver for 20. The facility was licensed on 06/01/21. There are currently 52 residents in assisted living and 24 residing in memory care. LPA spoke with Director of Assisted Living Roland Gandy and toured the facility with Lead Nurse, Chardonnay Blue.

Gandy and Blue confirmed that there had been a Covid-19 positive resident however the facility has completed its 2nd round of Covid testing on 8/26/21. While communal activities and gatherings are temporarily suspended, it will resume once all the test results show negative from the recent mass testing. The facility is following Community Care Licensing (CCL) approved Covid-19 mitigation procedures.

An exit interview was conducted with Mr. Gandy and a copy of this report was provided.
SUPERVISOR'S NAME: Nedra BrownTELEPHONE: (951) 248-0339
LICENSING EVALUATOR NAME: Anna BuenoTELEPHONE: 951-204-4307
LICENSING EVALUATOR SIGNATURE:

DATE: 08/27/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/27/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
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