<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 425801165
Report Date: 08/29/2024
Date Signed: 08/29/2024 03:20:01 PM

Document Has Been Signed on 08/29/2024 03:20 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		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 IFACILITY NUMBER:
425801165
ADMINISTRATOR/
DIRECTOR:		CLINTON CADLEFACILITY TYPE:
735
ADDRESS:943 SUNRISE DRIVETELEPHONE:
(805) 934-1089
CITY:SANTA MARIASTATE: CAZIP CODE:
93455
CAPACITY: 4CENSUS: 4DATE:
08/29/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Clinton Cadle, AdministratorTIME VISIT/
INSPECTION COMPLETED:
03:30 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 08/29/2024, Licensing Program Analyst (LPA) Brian Phillips conducted an unannounced Case Management-Incident visit to the facility above. LPA was accompanied on this visit by Tri-Counties Regional Center (TCRC) Vince Figueroa and Briana Hartwell. LPA and TCRC arrived at the facility, announced the purpose of the visit, and met with administrator Clinton Cadle. This case management was conducted simultaneously with the initial complaint investigation visit for complaint # 29-AS-20240826104343 and complaint #29-AS-20240829105037.

On 08/26/2024, the Department received a self-reported Unusual Incident/Injury Report (UIR) regarding client #1 (C1) alleging that they sustained a fall on 08/25/2024, by the facility administrator (name included on UIR). The UIR noted that on 03/25/2024, 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.

On 08/28/2024, the Department received a reported Unusual Incident/Injury Report (UIR) and SOC 341 Report of Suspected Dependent Adult/Elder Abuse. The UIR and SOC 341 were reported by a mandated reporter from the Adult Day Program (ADP) attended by clients of the facility above. The mandated reporter received information from a relative of Client #1 (C1) who stated that they received an email from someone that allegedly works at the facility above stating C1 was physically abused by two (2) caregivers. This alleged abuse by facility Staff is regarding the same incident self-reported by the facility on 08/26/2024 concerning a fall causing head trauma and hospital treatment by C1. Continued on 809-C
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Brian Phillips
LICENSING EVALUATOR SIGNATURE: DATE: 08/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/29/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: 08/29/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
On 08/26/2024, the Department received a SOC 341 Report of Suspected Dependent Adult/Elder Abuse reported by an individual stating they live in a home in the same neighborhood as the facility above. The SOC 341 reported that the neighbor has observed a caregiver from the facility pushing a client in care roughly into a facility transportation vehicle, and verbally abused the client in care. The SOC 341 reporter claims the facility staff member stops these actions when noticing they are being observed by the neighbor. However, the individual who stated they are a neighbor in a home next the the facility in the SOC 341 received by the Department on 08/26/2024 and in the complaint report for complaint # 29-AS-20240826104343 is the same individual who stated they work at the facility above and emailed the relative of C1 to allege physical abuse stated in the SOC 341 received by the Department on 08/28/2024. LPA could not find any indication this individual was employed at the facility above or by licensee in general through record review and Departmental Database(s).

The LPA conducted a physical tour observing the facility, requested documents for record review, and interviewed both Staff and clients of the facility. The LPA determined further investigation was needed prior to issuing findings.

Exit interview conducted. Copy of this report provided to the facility.
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Brian Phillips
LICENSING EVALUATOR SIGNATURE:

DATE: 08/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2024
LIC809 (FAS) - (06/04)
Page: 2 of 2