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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 360900053
Report Date: 08/19/2025
Date Signed: 08/19/2025 09:44:22 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO 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
04/14/2025 and conducted by Evaluator Beena Singh
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20250414083114
FACILITY NAME:BAKERS HOMEFACILITY NUMBER:
360900053
ADMINISTRATOR:BRADSHAW, JOHNFACILITY TYPE:
735
ADDRESS:16646 BASELINETELEPHONE:
(909) 823-5549
CITY:FONTANASTATE: CAZIP CODE:
92336
CAPACITY:6CENSUS: 0DATE:
08/19/2025
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Facility Licensee/ administrator John BradshawTIME COMPLETED:
12:15 PM
ALLEGATION(S):
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9
Staff hits residents.
Staff leave residents' unattended in vehicle.
Staff mishandled resident's personal funds.
INVESTIGATION FINDINGS:
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On 8/19/2025,Licensing Program Analyst (LPA) Beena Singh conducted an unannounced visit to deliver findings on the allegations listed above. LPA Singh met with Facility Licensee/ administrator John Bradshaw and explained the purpose of the visit.

First Allegation: Staff hit residents.
The investigation consisted of interviews with staff, clients, observations, and reviews of records. The allegation indicates staff hit residents.
Based on the information gathered, LPA Singh was not able to find sufficient evidence to corroborate the allegation listed above. Two (2) out of three (3) clients stated staff#1 has never hit the clients in their care, client#2 was not available to be interviewed. Three (3) out of three (3) staff stated staff #1 has never hit the clients in care.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Beena Singh
LICENSING EVALUATOR SIGNATURE:

DATE: 08/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2025
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 5
Control Number 56-AS-20250414083114
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: BAKERS HOME
FACILITY NUMBER: 360900053
VISIT DATE: 08/19/2025
NARRATIVE
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Sixth Allegation: Staff leave residents unattended in vehicle.

Based on the information gathered, LPA Singh was not able to find sufficient evidence to corroborate the allegation listed above. Two (2) out of three (3) clients stated staff has never left clients/residents in vehicle/car/van anytime ever., client#2 was not available to be interviewed. Three (3) out of three (3) staff stated staff have never left clients in their care unattended while out in the community for shopping or outings. Staff ensure clients are safe while going out in the facility vehicle and clients state they are not left unattended on outings in a vehicle.

Seventh Allegation: Staff mishandled resident's personal funds.

After records review and interview with relevant parties LPA Singh was not able to find sufficient evidence to corroborate the allegation listed above. All the clients have their Power of Attorney or Responsible party to manage their finances and staff do not mishandle residents’ personal funds. Client#1 had payee services who handled money for the client, services referred by the regional center and had client’s permission to handle client money, payee services has been stopped since client#1 has moved to different facility and client#1 did not give permission to payee services to handle Client#1s finances anymore.

Based on the evidence found during the investigation, the allegations listed above are deemed UNSUBSTANTIATED. A finding that the complaints are UNSUBSTANTIATED means although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur.

An exit interview was conducted, and a copy of this report LIC 9099, LIC9099 C was provided to the Licensee/Administrator, John Bradshaw.

SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Beena Singh
LICENSING EVALUATOR SIGNATURE:

DATE: 08/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO 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
04/14/2025 and conducted by Evaluator Beena Singh
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20250414083114

FACILITY NAME:BAKERS HOMEFACILITY NUMBER:
360900053
ADMINISTRATOR:BRADSHAW, JOHNFACILITY TYPE:
735
ADDRESS:16646 BASELINETELEPHONE:
(909) 823-5549
CITY:FONTANASTATE: CAZIP CODE:
92336
CAPACITY:6CENSUS: 0DATE:
08/19/2025
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Facility Licensee/ administrator John BradshawTIME COMPLETED:
12:15 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff serve moldy food to residents.
Staff do not ensure resident's showering needs are being met.
Staff did not allow resident to have dinner.
Staff do not ensure resident's clothing is in good repair.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
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9
10
11
12
13
On 8/19/2025, Licensing Program Analyst (LPA) Beena Singh conducted an unannounced visit to deliver findings on the allegations listed above. LPA Singh met with Facility Licensee/ administrator John Bradshaw and explained the purpose of the visit.

Second Allegation: Staff serve moldy food to residents.
During the investigation, LPA Singh was able to obtain sufficient evidence to corroborate the allegation. Two (2) out of three (3) clients stated that staff#1 served moldy food to clients in care. Three (3) out Three (3) staff stated staff#1 served moldy food to clients and ask the staff to give old leftovers food to clients in care.

Third Allegation: Staff do not ensure resident's showering needs are being met.
During the investigation, LPA Singh was able to obtain sufficient evidence to corroborate the allegation that Staff do not ensure resident's showering needs are being met.

Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Beena Singh
LICENSING EVALUATOR SIGNATURE:

DATE: 08/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 56-AS-20250414083114
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: BAKERS HOME
FACILITY NUMBER: 360900053
VISIT DATE: 08/19/2025
NARRATIVE
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Two (2) out of three (3) clients stated that staff#1 do not ensure resident's showering needs are being met. Three (3) out Three (3) staff stated staff#1 Staff do not ensure resident's showering needs are being met and clients were only allowed to take shower once a week.

Fourth Allegation: Staff did not allow residents to have dinner.

During the investigation, LPA Singh was able to obtain sufficient evidence to corroborate the allegation that Staff did not allow residents to have dinner.

Two (2) out of three (3) clients stated that staff#1 did not allow residents to have dinner. Three (3) out Three (3) staff stated staff#1 did not allow residents to have dinner and clients were unable to ask staff#1 for more food options.

Fifth Allegation: Staff do not ensure resident's clothing is in good repair.

During the investigation, LPA Singh was able to obtain sufficient evidence to corroborate the allegation that Staff did not allow residents to have dinner.

Two (2) out of three (3) clients stated that staff#1 do not ensure resident's clothing is in good repair. Three (3) out Three (3) staff stated staff#1 do not ensure resident's clothing is in good repair.

Based on LPAs observations and interviews which were conducted and record reviews, the preponderance if evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22 Division 6 & Chapter 6, are being cited on the attached LIC 9099D

Therefore, the allegations that; Staff serve moldy food to residents. Staff do not ensure resident's showering needs are being met, Staff did not allow resident to have dinner and that Staff do not ensure resident's clothing is in good repair was found to be SUBSTANTIATED. A finding that the complaint is substantiated means that the allegation is valid because the preponderance of the evidence standard has been met.

An exit interview was conducted, and a copy of this report LIC9099 A,LIC9099C LIC9099D was provided to the Licensee/Administrator, Mr. Bradshaw

SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Beena Singh
LICENSING EVALUATOR SIGNATURE:

DATE: 08/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 56-AS-20250414083114
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: BAKERS HOME
FACILITY NUMBER: 360900053
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/19/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/26/2025
Section Cited
CCR
85076(a-c)
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Food Service- 85076(a-c)
(a) In addition to Section 80076, the following shall apply.
(b) The licensee shall meet the food service personnel requirements specified in Section 85065(e) and 85065(e)(f).. This requirement is not met as evidenced by:
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Licensing will submit a statement of understanding on the regulation cited and hold a training with staff reviewing the regulation. Licensee/Administrator will submit proof of statement and staff acknowledment signatures to LPA via email by POC due date.
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Based on interviews, the Licensee/administrator did not comply with the section cited above by ensuring that staff did not serve moldy food to resident and staff did not allow resident to have dinner, which poses a potential health, safety and personal risk to persons in care.
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Type B
08/26/2025
Section Cited
CCR
85077(a)(b)
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85077 Personal Services
(a) Licensees shall provide necessary personal assistance and care, as indicated in the needs and services plan, with activities of daily living including but not limited to dressing, eating, and bathing.(b) Licensees shall provide basic laundry services, including washing and drying of clients' personal clothing..This requirement is not met as evidenced by:

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Licensing will submit a statement of understanding on the regulation cited and hold a training with staff reviewing the regulation. Licensee/Administrator will submit proof of statement and staff acknowledment signatures to LPA via email by POC due date
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Based on interviews, the Licensee/administrator did not comply with the section cited above by not ensuring that resident's clothing is in good repair and resident's showering needs are being met,which poses a potential health, safety and personal risk to persons in care.
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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: Efren Malagon
LICENSING EVALUATOR NAME: Beena Singh
LICENSING EVALUATOR SIGNATURE:

DATE: 08/19/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5