331881086-1-25-2022-18-AS-DMUN-CJRPZX-20220930114617

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331881086
Report Date: 01/25/2022
Date Signed: 01/25/2022 01:17:32 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
01/18/2022 and conducted by Evaluator Stephanie Torres

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20220118165549

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: 91	DATE:	01/25/2022
		UNANNOUNCED	TIME BEGAN:	12:15 PM
MET WITH:	Brittany Holm, Executive Director		TIME COMPLETED:	01:20 PM

ALLEGATION(S):

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Residents are being physically abused by staff

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 allegation. The LPA met with Executive Director (ED), Brittany Holm, and informed her of the purpose of the visit.

Pertaining to the allegation, "Residents are being physically abused by staff," it was alleged Resident One (R1) and other residents in care are being physically abused by facility staff. The LPA conducted staff and third party interviews. Interviews reported no knowledge of a resident by R1's name. The LPA reviewed the facility's resident roster and did not observe R1's name to be listed. Third-party interviews revealed R1 was recently admitted to another location. 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 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) 295-3927
LICENSING EVALUATOR SIGNATURE:	DATE: 01/25/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/25/2022

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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