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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 157208951
Report Date: 11/12/2021
Date Signed: 11/15/2021 12:23:23 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710
This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/28/2021 and conducted by Evaluator Lisa Salazar
COMPLAINT CONTROL NUMBER: 24-AS-20210528091733
FACILITY NAME:BUENA VISTA MANOR ARF INC.FACILITY NUMBER:
157208951
ADMINISTRATOR:BAGUIO, MIAFACILITY TYPE:
735
ADDRESS:11126 VISTA DEL VALLE DRIVETELEPHONE:
(661) 885-7838
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93311
CAPACITY:6CENSUS: DATE:
11/12/2021
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Administrator Mia Baguio, TIME COMPLETED:
10:45 AM
ALLEGATION(S):
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Staff financially abused a clients while in care
INVESTIGATION FINDINGS:
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On 11/12/21, Licensing Program Analysts (LPA) L. Salazar and Mai Yang met with Administrator Mia Baguio, to deliver findings on the above allegation.

During the course of the investigation, LPA conducted interviews with Licensee, R1's Social Worker, and Reporting party. LPA obtained and reviewed copies of Admission agreements (LIC 604a) and Invidivual Performance Plans (IPPs) for Resident R1(R1), Resident R2(R2) and Resident R3(R3). LPA also reviewed the Plan of Operation for the facility.

Admission agreements reveal that meals are included in the Basic Services which were being billed to Kern Regional Center/Department of Developmental Services. (DDS).

Licensee stated she was in possession, used and destroyed the CalFresh food benefits cards belonging to R1, R2, and R3. Licensee stated food was purchased for the facility as a whole. Based on a preponderance of evidence, the allegation that clients were financially abused while in care is SUBSTANTIATED.

A deficiency is being cited on the attached 9099D in accordance to California Code of Regulations, Title 22, Division 6, Chapter 8. Exit interview conducted. Appeal rights and report to be sent via email.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Lisa Salazar
LICENSING EVALUATOR SIGNATURE:

DATE: 11/12/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/12/2021
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 2
Control Number 24-AS-20210528091733
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: BUENA VISTA MANOR ARF INC.
FACILITY NUMBER: 157208951
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/12/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type A
11/16/2021
Section Cited
CCR
80026(f)
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80026 Safeguards for Cash Resources, Personal Property, and Valuables of Residents

(f) The licensee or employee of a licensee shall not make expenditures from clients' cash resources for any basic services in these regulations, or for any basic services identified in a contract/admission agreement between the client and the licensee. This requirement was not met as evidenced by records review and interviews that reveal CalFresh cards were obtained by Residents in care and used by the Licensee for the facility. This poses an immediate risk to residents in care.
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LPA is providing a copy of the regulation cited, Administrator and licensee will review with staff and submit signatures acknowledging that facility staff, licensee and Administrator understand these regulations.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Lisa Salazar
LICENSING EVALUATOR SIGNATURE:

DATE: 11/12/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/12/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 2