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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 425801343
Report Date: 06/09/2022
Date Signed: 06/09/2022 04:02:13 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
01/18/2022 and conducted by Evaluator Jeannette Olson
COMPLAINT CONTROL NUMBER: 29-AS-20220118103311
FACILITY NAME:BAUER RESIDENTIAL-SANTA MARIA IIFACILITY NUMBER:
425801343
ADMINISTRATOR:CLINTON CADLEFACILITY TYPE:
735
ADDRESS:3842 MIRA LOMA DRIVETELEPHONE:
(805) 938-9196
CITY:SANTA MARIASTATE: CAZIP CODE:
93455
CAPACITY:4CENSUS: 4DATE:
06/09/2022
UNANNOUNCEDTIME BEGAN:
03:30 PM
MET WITH:Clinton Cadle, Administrator over the phoneTIME COMPLETED:
04:15 PM
ALLEGATION(S):
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9
Facility is not following proper protocol for COVID-19
INVESTIGATION FINDINGS:
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13
Licensing Program Analyst (LPA) Olson conducted subsequent visit to deliver final findings. LPA met with Clinton Cadle, Administrator over the phone and explained the purpose of the visit.

On 1/20/22 at 12:00 PM, Licensing Program Analyst (LPA) Toan Luong arrived unannounced for an initial complaint inspection for the above allegation. LPA met with Administrator Clinton Cadle at 12:00 PM and explained the reason for the visit. LPA toured the facility and conducted interviews with staff.
Allegation: Facility is not following proper protocol for COVID-19. LPA Luong observed a trash bag hanging on the doorknob inside each of the clients’ rooms during initial complaint inspection. The trash bag did not have a lid. The facility followed all other COVID-19 protocols. LPA was screened at the entrance, staff were wearing full Personal Protective Equipment (PPE), signs were posted throughout the facility to promote good hygiene and social distancing. Bathrooms had soap, paper towels, and additional hand washing signs.
Continued on 9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Jeannette Olson
LICENSING EVALUATOR SIGNATURE:

DATE: 06/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2022
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-20220118103311
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: BAUER RESIDENTIAL-SANTA MARIA II
FACILITY NUMBER: 425801343
VISIT DATE: 06/09/2022
NARRATIVE
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LPA Luong observed the facility did not have a trash bin with a lid inside the clients’ rooms. The allegation Facility is not following proper protocol for COVID-19 did occur and is substantiated. An Advisory Note Technical Assistance is issued.

Exit interview, report emailed, Technical Assistance issued, appeal rights emailed.
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Jeannette Olson
LICENSING EVALUATOR SIGNATURE:

DATE: 06/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
01/18/2022 and conducted by Evaluator Jeannette Olson
COMPLAINT CONTROL NUMBER: 29-AS-20220118103311

FACILITY NAME:BAUER RESIDENTIAL-SANTA MARIA IIFACILITY NUMBER:
425801343
ADMINISTRATOR:CLINTON CADLEFACILITY TYPE:
735
ADDRESS:3842 MIRA LOMA DRIVETELEPHONE:
(805) 938-9196
CITY:SANTA MARIASTATE: CAZIP CODE:
93455
CAPACITY:4CENSUS: 4DATE:
06/09/2022
UNANNOUNCEDTIME BEGAN:
03:30 PM
MET WITH:Clinton Cadle, Administrator over the phoneTIME COMPLETED:
04:15 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility failed to meet resident's needs
Facility has an outbreak of COVID-19
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Olson conducted subsequent complaint visit to the facility. LPA met with Benjamin Martinez, Staff and Adminstrator Clinton Cadle over the phone and explained the purpose of the visit.

On 1/20/22 at 12:00 PM, Licensing Program Analyst (LPA) Toan Luong arrived unannounced for an initial complaint inspection for the above allegation. LPA met with Administrator Clinton Cadle at 12:00 PM and explained the reason for the visit. LPA toured the facility and conducted interviews with staff. LPA determined additional time is needed to complete the investigation.

Allegation: Facility has an outbreak of COVID-19. The facility self-reported multiple positive Covid-19 cases to CCL on 1/14/22 and 1/18/22. The facility fulfilled their reporting requirement to CCL. Based on the information obtained, the allegation is deemed unsubstantiated at this time.
Continued on 9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Jeannette Olson
LICENSING EVALUATOR SIGNATURE:

DATE: 06/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2022
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 4
Control Number 29-AS-20220118103311
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: BAUER RESIDENTIAL-SANTA MARIA II
FACILITY NUMBER: 425801343
VISIT DATE: 06/09/2022
NARRATIVE
1
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3
4
5
6
7
8
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12
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Allegation: Facility failed to meet resident's needs. It was alleged that the facility is not meeting the needs of Client #1 (C1). C1 was sent to the hospital on 1/13/22 and returned back to the facility. Interview with the Administrator Cadle reveals that the client was not able to be transferred to a skilled nursing facility due to the skilled nursing facility reaching maximum capacity. LPA reviewed Incident Reports report dates 1/13/22 and 1/14/22. Documents reported after C1’s discharge from the hospital on the evening of 1/13/22, the facility was notified C1 was COVID-19 positive the following morning. The client had an appointment with their Primary Care Physician and monitored C1’s oxygen levels. C1’s oxygen level was low for C1’s standard, and C1 was brought to the hospital and remained there until 1/18/22. Based on the information obtained, the allegation is deemed unsubstantiated at this time.

Exit interview, report emailed.
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Jeannette Olson
LICENSING EVALUATOR SIGNATURE:

DATE: 06/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2022
LIC9099 (FAS) - (06/04)
Page: 4 of 4