425801165-11-18-2024-29-AS-KBUY-DBD4TY-20241125182354

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 425801165
Report Date: 11/18/2024
Date Signed: 11/18/2024 02:14:19 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
10/31/2024 and conducted by Evaluator Brian Phillips

COMPLAINT CONTROL NUMBER: 29-AS-20241031151222

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: 3	DATE:	11/18/2024
		UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Clinton Cadle, Administrator		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Licensee does not ensure facility staff are adequately trained.
Licensee allows staff to work and live at the facility without fingerprint clearance.
Facility staff are not addressing resident's dental needs.
Facility staff does not ensure adequate amount of food supply for residents.
Facility staff are not changing residents bedding frequently enough.

INVESTIGATION FINDINGS:

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On 11/18/2024, Licensing Program Analyst (LPA) Brian Phillips conducted a subsequent complaint investigation visit to deliver final findings for the above allegation. During this visit, LPA met with Administrator Clinton Cadle and explained the reason for the visit.

On the allegation: Licensee does not ensure facility staff are adequately trained. It is alleged that counterfeit/fake Crisis Prevention and Intervention (CPI) training certificates are made for some facility staff, while other staff have CPI training certificates that have been expired for years. It is also alleged that staff who provide care and supervision to clients in care have no training.

On 11/06/2024, Licensing Program Analyst (LPA) Brian Phillips conducted an unannounced initial complaint investigation visit to the facility above. During this visit, LPA requested and received facility documentation relevant to the allegations in the complaint for record review. The facility keeps confidential storage of personnel records and client records on-site at the facility. Continued on 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Brian Phillips
LICENSING EVALUATOR SIGNATURE:	DATE: 11/18/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2024

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 5

Control Number 29-AS-20241031151222

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: 11/18/2024

NARRATIVE

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Personnel records reviews were reviewed for, but not limited to valid current First Aid/CPR training, and additional training documentation including valid CPI trainings. LPA received training paperwork for each employee signed and dated by a certified training instructor/professional. These trainings included Abuse Reporting, Guidance of Food Safety & Storage, Spectrum of Autism, Guidance for Storage of Uncooked Food, Medication Rights, COVID-19 Requirements, CPR/AED & First Aid, Medication Administration, Proper Cleaning Procedures, Mandatory Reporting Requirements, Direct Support Professional Training, Crisis Prevention and Intervention (CPI) training, and New Employee Orientation Trainings. The New Employee Orientation Trainings consist of trainings on the facility program design, client Individual Program Plans (IPP/ISP), consumer rights regulations, prescribed medication assistance, health & emergency procedures, special incidents/reporting abuse, and emergency disaster training/infection control plan training. All training documentation received by LPA had the number of hours listed per training, the date of completion, and the expiration dates. All staff member personnel records had documentation of appropriate training hours/certification including CPI trainings with no expiration of any training. All personnel records contained documentation of CPI training through Crisis Prevention Institute, Inc. which is an organization that provides training programs teaching crisis intervention and de-escalation skills to help reduce challenging behavior and prevent future incidents. After completion of CPI training, the Certified Instructor from the organization provides a copy of a CPI training verification cared including hours completed, expiration date, and instructor signature. The instructor also updates certification details online, which an employer can use to verify certification. Based on the information gathered, there is insufficient evidence to prove the alleged violation occurred. Therefore, the allegation is unsubstantiated.

On the allegation: Licensee allows staff to work and live at the facility without fingerprint clearance. It is alleged staff of the facility above are illegal immigrants that are not legally allowed to work in the United States. It is also alleged that staff use false/fake social security numbers which do not show criminal convictions from the country of origin. Allegedly certain staff members are not associated to the facility or fingerprinted for a criminal background check but work and live in the facility.

LPA received an LIC 500 Personnel Report and individual background check clearance documentation for each employee working in the facility. Facility personnel records reviews were reviewed for, but not limited to LIC 501 personnel records, LIC 503 health assessments with Tuberculosis (TB) test results, Personnel Action Notice, Job Description with date of employment, LIC 9052 Employee Rights, LIC 508 criminal record Statements, and criminal record clearances or criminal record exemptions. Continued on 9099-C

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Brian Phillips
LICENSING EVALUATOR SIGNATURE:	DATE: 11/18/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2024

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20241031151222

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: 11/18/2024

NARRATIVE

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LPA reviewed the employee fingerprinting/background check clearances as well as the employee associations to the facility above on the Licensing Agency electronic data system, which documents the background check process for all licensed care. LPA observed that all employees working in the facility, and documented on the facility LIC 500 Personnel Report, had eligible background check clearances or background check exemptions verified in the Licensing Agency electronic data system. All staff working in the facility above were observed by LPA to be associated to the facility above in the Licensing Agency electronic data system. Facility personnel records all contained background check clearance documentation for each staff member working in the facility. There is no evidence obtainable by the Licensing Agency indicating any fraudulent social security numbers being used by facility staff. LPA conducted unannounced/unscheduled visits to the facility on 8/29/2024, 9/16/2024, 9/30/2024, 11/6/2024, and 11/18/2024. During all visits by LPA, all individuals in the facility observed by LPA were documented on the facility roster and associated/cleared to be in the facility. Based on the information gathered, there is insufficient evidence to prove the alleged violation occurred. Therefore, the allegation is Unsubstantiated.

On the allegation: Facility staff are not addressing resident's dental needs. It is alleged that the facility is not providing proper dental medical attention to the clients, and it has been years since clients were seen by a dentist.

The facility keeps confidential storage of client records on-site at the facility. Client records were reviewed by the LPA for, but not limited to, Pre-Admission/Placement appraisals, Admission Agreements, Physicians Reports, Consent Forms, Personal Rights Forms for Clients, Emergency Information, Release of Medical Information, Needs and Services Plan (ANS)/Individual Program Plan (IPP), Client Assessments, Self-management of medications if applicable, Medication Orders, and Medication Logs. LPA observed that all client Physicians Report (LIC 602) Medical assessments include Tuberculosis (TB) test results; ambulatory status; record of illnesses and medical care provided; evidence or periodic medical examination and care; and record of changes in physical, mental emotional and social functioning of residents. LPA observed that the Physicians Report assessments were not more than one year old when obtained. LPA additionally observed that all client records contained signed and dated LIC 627C Consent for Medical Treatment documentation. All client records maintained by the facility contained documentation of medical assessments/medical services provided to each client including the provision of proper dental attention. The facility above is served by a Regional Center Agency due to developmentally disabled clients in care. Continued on 9099-C

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Brian Phillips
LICENSING EVALUATOR SIGNATURE:	DATE: 11/18/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2024

LIC9099 (FAS) - (06/04)

Page: 3 of 5

Control Number 29-AS-20241031151222

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: 11/18/2024

NARRATIVE

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The Regional Center uses Service Coordinators to assist the facility in processing Individual Program Plans (IPP) for each client in care. The IPP process explores the services and supports important for each client including medical and dental services. Medical and dental service decisions in each client’s IPP are made in collaboration with the Regional Center Service Coordinator. All facility documentation reviewed by LPA, Regional Center documentation reviewed by LPA, and all interviews conducted by LPA provided evidence that the facility is providing proper medical attention to clients, including addressing the clients’ dental needs. All staff interviewed by LPA stated that they arrange, or assist in arranging, medical and dental care appropriate to the conditions and needs of clients. This includes transportation to available medical or dental facilities which will meet the clients needs. Based on the information gathered, there is insufficient evidence to prove the alleged violation occurred. Therefore, the allegation is Unsubstantiated.

On the allegation: Facility staff does not ensure adequate amount of food supply for residents. It is alleged that the Licensee/facility neglects spending money on food supplies for clients in the facility, spending only $250 every second Wednesday.

LPA conducted unannounced visits to the facility above on 8/29/2024, 9/16/2024, 9/30/2024, 11/6/2024, and 11/18/2024. During each of these visits, LPA observed the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. During each visit to the facility above, LPA inspected the kitchen/food service area and observed that perishable food items were in good condition, with proper expiration dates precluding the perishable items from expiring. The facility was observed during all visits to have a sufficient supply of perishable and non-perishable food, which would last seven (7) days or more. Additional perishable food items were maintained on shelves in a pantry storage area and in an extra freezer in the garage area of the facility. The kitchen was clean and sanitary, with covered trashcans and operating ventilation systems. No toxic substances are stored in any food preparation or storage area, and all cleaning supplies for the kitchen are kept in a separate area than the food supplies. The freezer and refrigerator were both in the appropriate temperate Fahrenheit. There is enough tableware and utensils for all residents living in the facility, and enough equipment for the storage, preparation, and service of food. All staff interviewed by LPA stated that they ensure an appropriate/adequate amount of food supply is maintained for all clients in care at the facility. This includes maintaining a supply of perishable food and checking expiration dates, maintaining a supply of non-perishable food, and purchasing the necessary food supplies on a consistent basis for the facility. Continued on 9099-C

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Brian Phillips
LICENSING EVALUATOR SIGNATURE:	DATE: 11/18/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2024

LIC9099 (FAS) - (06/04)

Page: 4 of 5

Control Number 29-AS-20241031151222

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: 11/18/2024

NARRATIVE

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

On the allegation: Facility staff are not changing residents bedding frequently enough. It is alleged that the linens and bedding in each client’s bedroom is not being changed and/or washed for weeks at a time.

During all unannounced/unscheduled visits to the facility above by LPA, the physical plant areas inside and outside the facility were observed and evaluated. The LPA observed the client bedrooms, which were furnished appropriately with clean linens, appropriate furnishings, and sufficient lighting. Each client bedroom has a bed, nightstands, and lights and nightstand lamps to provide sufficient lighting. Each closet in all the client rooms can store or has extra pillows, clean/fresh linens, and appropriate incontinence materials if applicable for any client. The client bedrooms are big enough for all beds, furniture, and any client assisting device a client might need such as a wheelchair or a walker. Each room has sufficient lighting for each client. The facility has provisioned to each client of furniture, equipment and supplies necessary for personal care and maintenance of personal hygiene. The facility has a sufficient supply of linens to permit weekly changing or more often to always ensure clean linens for clients in care. LPA additionally observed a designated laundry area in the facility, containing a washer and dryer and is where cleaning products are stored, which are kept locked and inaccessible to clients. The laundry area is accessible through the common area of the facility as a specific room off the main hallway. The main hallway of the facility also contains storage areas for additional clean linens, pillowcases, and bedding for each client bedroom. During each visit by LPA, the bedding/sheets on client beds were observed to be clean, with no discoloration nor odor. LPA also observed staff members doing laundry in the facility consisting of client bedding on more than one occasion during the recent visits by LPA. All staff interviewed by LPA stated that they ensure the clients bedding, bedsheets, pillowcases, and blankets are cleaned and changed on a regular basis with staff members having a frequent laundry schedule and the ability to clean/change client bedding on an as needed basis as well. Based on the information gathered, there is insufficient evidence to prove the alleged violation occurred. Therefore, the allegation is Unsubstantiated.

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

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Brian Phillips
LICENSING EVALUATOR SIGNATURE:	DATE: 11/18/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2024

LIC9099 (FAS) - (06/04)

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