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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 405801714
Report Date: 08/29/2025
Date Signed: 08/29/2025 11:23:32 AM

Document Has Been Signed on 08/29/2025 11:23 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME:BAUER RESIDENTIAL-NIPOMOFACILITY NUMBER:
405801714
ADMINISTRATOR/
DIRECTOR:		SHIRLET HALLIDAYFACILITY TYPE:
735
ADDRESS:890 PROSPERITY WAYTELEPHONE:
(805) 929-5758
CITY:NIPOMOSTATE: CAZIP CODE:
93444
CAPACITY: 4CENSUS: 4DATE:
08/29/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
07:44 AM
MET WITH:Administrator, Shirlet HallidayTIME VISIT/
INSPECTION COMPLETED:
11:23 AM
NARRATIVE
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 At 8:00am on 08/29/2025, Licensing Program Analyst (LPA) Jeffries and Miguel Magana of Tri Counties Regional Center (TCRC) Quality Assurance Specialist (QA) arrived unannounced to the facility. LPA and QA met with Administrator, Shirlet Halliday, announced who they are and the reason for the visit. This is a case management visit pertaining to an incident from Serious Incident Report (SIR) of a staff hitting a client on 08/24/2025 (Saturday night into Sunday early morning shift time). QA and LPA conducted interviews of staff and Administrator. QA conducted an interview of Administrator on 08/26/2025, where Administrator stated that the facility contacted the San Luis Obispo County's Sheriff Department (report# 2508 05583, Deputy Hundsinker) on 08/26/2025 for the physical assault of client by staff. LPA noted staff currently working were not working during, before, or shortly after the time of the incident and did not have details on the incident. QA and LPA observed a discoloration on Client 1 (C1) in the left temple side of head, however unable to determine of discoloration was a result of the assault. Due to the described physical assault of C1 by Staff 1 (S1) a citation of Personal Rights (80072) is assessed at this time. Additionally, because the facility did not report physical abuse, that did not result in great bodily harm within the 24 hours, being a regulation requirement, a citation of Reporting Requirement's (80061) is also issued at this time. Community Care Licensing will continue to follow up on this incident.

Exit interview, report read, citations issued, appeal rights and report provided.

NAME OF LICENSING PROGRAM MANAGER: Kelly Burley
NAME OF LICENSING PROGRAM ANALYST: Mark Jeffries
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 08/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/29/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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Document Has Been Signed on 08/29/2025 11:23 AM - It Cannot Be Edited


Created By: Mark Jeffries On 08/29/2025 at 08:35 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: BAUER RESIDENTIAL-NIPOMO
FACILITY NUMBER: 405801714

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/29/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/01/2025
Section Cited
CCR
80061(b)

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80061 Reporting Requirements
(d) Any suspected physical abuse that does not result in serious bodily injury of an elder or dependent adult shall be reported to the local ombudsman, the corresponding licensing agency, and the local law enforcement agency within twenty-four (24)
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Administrator agrees to complete 1 hours mandated reporter training that is vender approved by TCRC and CCLD. Email approval by QA Miguel Magan. Email completed training by all facility staff (Guardian Rouster) to LPA Jeffries (mark.jeffries@dss.ca.gov)
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hours as required by Welfare and Institutions Code Section 15630(b)(1). This regulations was not by evidence of reporting staff striking Client in care several times and waiting past 24 hours to report, which poses imminent danger to clients in care.
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Type A
09/01/2025
Section Cited
CCR80072(a)(3)

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(a) Except for children’s residential facilities, each client shall have personal rights which include, but are not limited to, the following:(3) To be free from corporal or ... infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse, or other actions of a punitive nature, including but
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Administrator agrees to complete 1 hours Personal Rights training that is vender approved by TCRC and CCLD. Email approval by QA Miguel Magan. Email completed training by all facility staff (Guardian Rouster) to LPA Jeffries (mark.jeffries@dss.ca.gov)
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 not limited to: interference with the daily living functions, including eating, sleeping, or toileting; or withholding of shelter, clothing... By evidence of reporting staff striking Client in care several times, which poses imminent danger to clients 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.
Kelly Burley
NAME OF LICENSING PROGRAM MANAGER:
Mark Jeffries
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 08/29/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/29/2025


LIC809 (FAS) - (06/04)
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