Health inspection·November 8, 2023

F 0610 Respond appropriately to all alleged violations. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to protect other residents from potential abuse while the investigation was in progress, for two of seven residents reviewed (Resident 1 and Resident 2), when: Residents Affected - Few 1. The Certified Occupational Therapy Assistant (COTA); and 2. Certified Nurse Assistant (CNA) were allowed to continue to work pending the results of the alleged abuse. These failures had the potential to place the other residents in the facility at risk for abuse. Findings: 1. During a review of Resident 1's Progress Notes (PN), dated October 4, 2023 (late entry for October 3, 2023), the PN indicated Resident 1 stated the COTA was rough with him during a shower on September 27, 2023. During a review of Resident 1's admission Record (AR), the AR indicated Resident 1 was admitted to the facility on [DATE], with diagnoses which included hypertension (high blood pressure) and generalized muscle weakness. During an interview on October 16, 2023, at 10:25 a.m., with the COTA, she stated the Physical Therapy Director (PTD) called her on October 3, 2023, at 5:36 p.m. The COTA stated the PTD told her Resident 1 claimed physical abuse against her. The COTA stated she was taken off Resident 1's schedule and was told to come to work. The COTA stated she was not placed on leave and worked on October 4, 2023. During an interview on October 16, 2023, at 11:18 a.m., with the Physical Therapy Assistant (PTA), she stated to her knowledge, the COTA was allowed to work while the investigation on the abuse allegation was on-going. The PTA stated she thought the COTA should have been taken off the schedule pending the investigation. The PTA stated she was not sure why the COTA was allowed to work while the investigation was still pending. The PTA stated the COTA was removed from Resident 1's scheduled therapies. During an interview on October 16, 2023, at 11:30 a.m., with Resident 1, in his room, Resident 1 stated the COTA was abusive to him. Resident 1 stated the COTA came to his room intentionally slamming things around. Resident 1 stated the COTA offered him to shower. Resident 1 stated the COTA was rough handling the shower chair and they had some verbal exchanges in the shower stall. Resident 1 (continued on next page) Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE FORM CMS-2567 (02/99) Previous Versions Obsolete Facility ID: If continuation sheet Page 1 of 3 Event ID: 555775 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 555775 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/08/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bayshire Rancho Mirage 72-201 Country Club Drive Rancho Mirage, CA 92270 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)