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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331881086
Report Date: 04/29/2026
Date Signed: 04/29/2026 10:14:44 AM

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
02/04/2025 and conducted by Evaluator Seo Jeon
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20250204093310
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: 119DATE:
04/29/2026
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Michael Maeda, Resident Service DirectorTIME COMPLETED:
10:30 AM
ALLEGATION(S):
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Staff did not provide adequate meals to residents in care
Residents are not provided sufficient activities
Staff did not update resident's care plan
Staff did not provide timely assistance to resident in care
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Seo Jeon conducted an unannounced visit to the facility to deliver findings of the above allegations. LPA met with Michael Maeda, Resident Service Director and informed them of the purpose of the visit. The Department’s investigation involved interviews with staff and residents and review of records.

On February 4, 2025, Community Care Licensing (The Department) received a complaint report with the following allegations.

It was alleged that staff did not provide adequate meals to residents in care. Information received indicated that quality of facility food served has gone down with the current food service manager. LPA conducted interviews with nine (9) residents. Five (5) residents interviewed stated that the food service has been good. Four (4) residents interviewed stated that the food service has been about average.
Continued on LIC9099-C....
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Rikesha Stamps
LICENSING EVALUATOR NAME: Seo Jeon
LICENSING EVALUATOR SIGNATURE:

DATE: 04/29/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
Control Number 18-AS-20250204093310
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: 04/29/2026
NARRATIVE
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Two (2) of the residents interviewed were involved in the facility resident council and stated that the facility management was in the process of hiring a new food service manager. Based on the interviews conducted, the Department’s investigation did not provide enough information to corroborate the allegation that staff did not provide adequate meals to residents in care. This allegation is unsubstantiated.

It was alleged that residents are not provided sufficient activities. Information received indicated that the facility currently offer only one (1) or two (2) activities per day. LPA conducted a tour of the facility and observed a monthly activities calendar posted at the reception area. The activities calendar showed five (5) to six (6) activities per day, 7 days a week. LPA conducted interviews with nine (9) residents, all of whom confirmed the number of activities provided for the residents in care. LPA conducted an interview with the activities director who also confirmed the number of activities. This allegation is unsubstantiated.

It was alleged that staff did not update resident’s care plan. LPA conducted interviews with the Administrator and Resident Service Director, both of whom stated that residents’ care plans are updated as needed when there are any changes in condition. Care plans are discussed with residents and/or residents’ responsible persons and usually stay the same unless any changes are requested. LPA conducted interviews with nine (9) residents. Three (3) residents interviewed have resided less than one (1) year and stated that they have discussed their care plans during the admission process. Five (5) residents interviewed confirmed that their care plans stayed the same after annual meeting. One (1) resident interviewed did not remember if there was any care plan. Based on interviews conducted, the Department’s investigation did not provide enough information to corroborate the allegation that staff did not update resident’s care plan. This allegation is unsubstantiated.

It was alleged that staff did not provide timely assistance to resident in care. Information received indicated that there were three (3) instances where only one (1) caregiver on shift at night in the past two weeks. LPA conducted interviews with nine (9) residents, all of whom stated that they have received good services from the caregivers from both day and night shifts. LPA conducted interviews with two (2) staff members, both of whom stated that staff coverage is generally adequate, though shortages occur when a scheduled employee does not show up for work. In those instances, the staff member on duty is required to cover the vacancy. Based on interviews conducted, the Department’s investigation did not provide enough information to corroborate the allegation that staff did not provide timely assistance to resident in care. This allegation is unsubstantiated. Continued on LIC9099-C....

SUPERVISORS NAME: Rikesha Stamps
LICENSING EVALUATOR NAME: Seo Jeon
LICENSING EVALUATOR SIGNATURE:

DATE: 04/29/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 18-AS-20250204093310
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: 04/29/2026
NARRATIVE
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A finding that the complaint is UNSUBSTANTIATED means the allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred.

An exit interview was conducted where a copy of this report was provided.
SUPERVISORS NAME: Rikesha Stamps
LICENSING EVALUATOR NAME: Seo Jeon
LICENSING EVALUATOR SIGNATURE:

DATE: 04/29/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 3