331881086-11-9-2022-18-AS-DMUN-CLFTU5-20221123140144

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331881086
Report Date: 11/09/2022
Date Signed: 11/09/2022 02:32:00 PM

Unsubstantiated

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
02/22/2022 and conducted by Evaluator Jesse Gardner

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20220222110428

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: 100	DATE:	11/09/2022
		UNANNOUNCED	TIME BEGAN:	12:09 PM
MET WITH:	Brittany Holm, Administrator		TIME COMPLETED:	02:45 PM

ALLEGATION(S):

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Staff did not safeguard resident's personal belongings.
Facility does not have adequate staff to meet the needs of the residents.

INVESTIGATION FINDINGS:

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Licensing Program Analyst, Jesse Gardner conducted an unannounced visit to deliver the findings of the above allegations. At the time of visit, there were 100 residents with 76 in Assisted Living. The investigation included interviews with facility staff, residents and confidential witnesses and a review of Resident 1’s (R1’s) facility and records.

It was alleged that R1 had a wedding ring on when R1 checked into the facility, and when R1 left, the ring was missing. Regarding the allegation, "Staff did not safeguard resident's personal belongings",
*Continued on LIC9099-C.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Deborah Mullen	TELEPHONE: (951) 248-0313
LICENSING EVALUATOR NAME: Jesse Gardner	TELEPHONE: (951) 205-2683
LICENSING EVALUATOR SIGNATURE:	DATE: 11/09/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2022

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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Control Number 18-AS-20220222110428

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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 MIRAGE	FACILITY NUMBER: 331881086
	VISIT DATE: 11/09/2022

NARRATIVE

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LPA conducted interviews with staff, and residents, reviewed records and found that the facility provided the necessary tools to safeguard R1's belongings. When R1 checked in, R1's responsible party did not complete a client/resident personal property and valuables form. When a report was made that the ring was missing, the facility interviewed residents and each signed a statement that they looked for the ring, and could not locate it. The facility, also, sent out a memorandum to the residents to be on the lookout for a lost ring. In addition, LPA noted that there were no belongings found on R1 when R1 was picked up by the mortician from the facility.

It was also alleged that there was not enough staff to assist the residents. Regarding the allegation, "Facility does not have adequate staff to meet the needs of the residents." LPA reviewed records for the time period that R1 resided at the facility, and found that there were on average approximately 15.8 care staff for 63 residents. Through interviews conducted during today's visit, LPA found that there were no staffing concerns with meeting the needs of residents.

Therefore, the allegation, "Staff did not safeguard resident's personal belongings" and, "Facility does not have adequate staff to meet the needs of the residents" were found to be UNSUBSTANTIATED. A finding of UNSUBSTANTIATED means that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur.

An exit interview was conducted where a copy of this report was discussed with and provided to Administrator Brittany Holm along with a copy of the LIC811.

SUPERVISOR'S NAME: Deborah Mullen	TELEPHONE: (951) 248-0313
LICENSING EVALUATOR NAME: Jesse Gardner	TELEPHONE: (951) 205-2683
LICENSING EVALUATOR SIGNATURE:	DATE: 11/09/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2022

LIC9099 (FAS) - (06/04)

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