425801165-9-30-2024-29-AS-KBUY-D9LVN5-20240930163433

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 425801165
Report Date: 09/30/2024
Date Signed: 09/30/2024 01:53:27 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS NORTH, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/26/2024 and conducted by Evaluator Brian Phillips

COMPLAINT CONTROL NUMBER: 29-AS-20240826104343

FACILITY NAME:	BAUER RESIDENTIAL SANTA MARIA I		FACILITY NUMBER:	425801165
ADMINISTRATOR:	CLINTON CADLE		FACILITY TYPE:	735
ADDRESS:	943 SUNRISE DRIVE		TELEPHONE:	(805) 934-1089
CITY:	SANTA MARIA	STATE: CA	ZIP CODE:	93455
CAPACITY:	4	CENSUS: 4	DATE:	09/30/2024
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Clinton Cadle, Administrator		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

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Staff handled resident roughly
Staff yells at resident

INVESTIGATION FINDINGS:

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On 09/30/2024, Licensing Program Analyst (LPA) Brian Phillips conducted an unannounced subsequent complaint investigation visit to the facility above to deliver final findings for the above allegation. During today’s visit, LPA Phillips met with Administrator Clinton Cadle and explained the reason for the visit.

On the allegation: Staff handled resident roughly. It is alleged that a staff member of the facility above is physically rough with Client #1 (C1) while assisting with loading and unloading the facility transportation vehicle to and from C1’s Adult Day Program (ADP). Allegedly the staff member pushes C1 into the facility van forcefully and C1 is often screaming and yelling as if they are in pain. According to the allegation, the staff member changes their physically rough behavior with C1 when they are around others.

On 08/29/2024 and 09/16/2024, LPA conducted complaint investigation visits to the facility above. During these visits, LPA conducted interviews with both staff and residents, as well as received relevant facility documentation pertinent to the allegation above. Continued on 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Brian Phillips
LICENSING EVALUATOR SIGNATURE:	DATE: 09/30/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2024

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 4

Control Number 29-AS-20240826104343

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS NORTH, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: BAUER RESIDENTIAL SANTA MARIA I	FACILITY NUMBER: 425801165
	VISIT DATE: 09/30/2024

NARRATIVE

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LPA requested and received documented facility daily progress notes at the times of day when clients are loaded and unloaded to and from their Adult Day Program (ADP). There are no documented entries from any staff member concerning the treatment or status of C1 regarding facility loading and unloading procedures. LPA additionally requested and received documented communication between the facility above and the ADP of C1. The documented facility communication with the ADP had no statements from the ADP about any concern over the procedures of loading and unloading by facility staff. All LPA interviews with facility staff, clients, and credible witnesses from outside the facility have no concern over the physical and verbal procedures of facility staff members when loading/unloading clients at any time for any reason. LPA was provided with a recorded video that was allegedly presented by RP as a “hidden camera” recording of the facility staff loading/unloading clients in care. LPA did not observe any inappropriate physical or verbal behavior by staff while loading/unloading clients at the facility. On 08/29/2024 and 09/16/2024 while at the facility, LPA physically observed facility staff unloading clients from their ADP. The procedures used by staff at the facility appeared appropriate as observed by LPA. Through observation by LPA of both the recorded video and onsite in person of staff loading/unloading clients, there was no physical behavior observed by LPA that could be interpreted as forceful pushing of clients.

On 08/26/2024, the Department received a self-reported Unusual Incident/Injury Report (UIR) regarding C1 alleging that they sustained a fall on 08/25/2024, resulting in a head injury requiring medical treatment. The UIR noted that on 08/25/2024, at approximately 8:30pm, C1 was returning from the restroom and upon entry to the dining room stopped to pick up food that had fallen to the floor from the dining room table. C1 lost their balance and fell hitting the back of their head on the edge of the wall. Staff immediately assisted C1 and checked them for injuries but did not observe any injuries. Around 10:30pm, the facility changed shifts and the incident was relayed to the nocturnal shift. Staff checked on C1 and noticed blood on C1’s bedroom pillow and found a laceration on the back of C1’s head. Staff immediately took C1 to the Emergency Room (ER) hospital where C1 received three (3) staples to the head wound and was told to follow up with primary care physician. C1 was discharged to the facility the same night. LPA received documented hospital discharge paperwork and facility narrative charting regarding this incident which corroborates the statement of facts presented by the facility in the UIR to the department. LPA interviewed both facility staff and clients in care regarding this incident as a Case Management Visit to the facility above on 08/29/2024. There is no evidence through interviews by LPA or record review conducted by LPA that the injury to C1 on 08/25/2024 was caused by staff roughly handling C1 while loading and/or unloading C1 in the facility transportation vehicle. Continued on 9099-C

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Brian Phillips
LICENSING EVALUATOR SIGNATURE:	DATE: 09/30/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 29-AS-20240826104343

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS NORTH, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: BAUER RESIDENTIAL SANTA MARIA I	FACILITY NUMBER: 425801165
	VISIT DATE: 09/30/2024

NARRATIVE

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On 08/28/2024, a responsible party for C1 indicated to the ADP of C1 that they had been contacted by an alleged staff member of the facility above regarding rough physical treatment of C1 in care. The responsible party of C1 provided the name of the alleged staff member who provided this information, but LPA could not find any record of a staff member by that name working in the facility. LPA interviewed facility staff as well as requested and received an LIC 500 Personnel Record from the facility. There is no record of an employee by this name working at the facility and other staff had no knowledge of anyone by this name working at the facility. LPA could not find this name associated to any facility run by the Licensee.

Based on the information gathered, there is insufficient evidence to prove the alleged violation occurred. Therefore, the allegation is Unsubstantiated.

On the allegation: Staff yells at resident. It is alleged that a staff member of the facility above is verbally abusive to Client #1 (C1) while assisting with loading and unloading the facility transportation vehicle to and from C1’s Adult Day Program (ADP). Allegedly the staff member yells at C1 even though they appear to be in pain.

LPA conducted record review of relevant documents pertinent to the allegation above including facility narrative charting, daily progress notes, communications with the ADP of C1, and any UIRs received by the Department regarding C1 on both 08/29/2024 and 09/16/2024. There are no documented entries from any staff member at the facility in any facility narrative charting or daily progress notes concerning the treatment or status of C1 while loading/unloading in the facility transportation vehicle. The documented facility communication with the ADP of C1 had no statements from the ADP about any concern over the procedures of loading and unloading by facility staff including verbal treatment of clients by facility staff. All LPA interviews with facility staff, clients, and credible witnesses from outside the facility have no concerns or issues over the verbal procedures of facility staff members when loading/unloading clients at any time for any reason. The “hidden camera” video/audio recording provided to LPA on 09/03/2024 of the facility staff loading/unloading clients in care did not have any observable inappropriate verbal behavior by staff while loading/unloading clients at the facility. On 08/29/2024 and 09/16/2024 while at the facility, LPA physically observed facility staff unloading clients from their ADP. The procedures used by staff at the facility appeared appropriate as observed by LPA. Through observation by LPA of both the recorded video and onsite in person of staff loading/unloading clients, there was no verbal behavior observed by LPA that could be interpreted as yelling at the clients. Continued on 9099-C

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Brian Phillips
LICENSING EVALUATOR SIGNATURE:	DATE: 09/30/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2024

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 29-AS-20240826104343

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS NORTH, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: BAUER RESIDENTIAL SANTA MARIA I	FACILITY NUMBER: 425801165
	VISIT DATE: 09/30/2024

NARRATIVE

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A majority of the staff members at the facility interviewed by LPA on 08/29/2024 and 09/16/2024 stated that they believed allegations of staff physical and/or verbal mistreatment of clients in care at the facility were being falsely reported to the Department due to internal divisions/grudges between certain Staff members at the facility and previous divisions between staff, relatives of staff, and significant others of staff at various facilities run by the Licensee.

Based on the information gathered, there is insufficient evidence to prove the alleged violation occurred. Therefore, the allegation is Unsubstantiated.

Exit interview conducted. Copy of this report provided to the facility.

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Brian Phillips
LICENSING EVALUATOR SIGNATURE:	DATE: 09/30/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2024

LIC9099 (FAS) - (06/04)

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