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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 425801936
Report Date: 10/28/2022
Date Signed: 10/28/2022 03:26:31 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
08/31/2022 and conducted by Evaluator Jeannette Olson
COMPLAINT CONTROL NUMBER: 29-AS-20220831122413
FACILITY NAME:BAUER RESIDENTIAL SANTA MARIA 4FACILITY NUMBER:
425801936
ADMINISTRATOR:MOSHE DAVISFACILITY TYPE:
735
ADDRESS:572 INGER DRIVETELEPHONE:
(714) 306-4068
CITY:SANTA MARIASTATE: CAZIP CODE:
93454
CAPACITY:6CENSUS: 4DATE:
10/28/2022
UNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Moshe Davis, AdministratorTIME COMPLETED:
03:30 PM
ALLEGATION(S):
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Staff are not providing adequate support to address resident’s needs
Facility is unlawfully evicting resident
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Olson conducted a subsequent complaint visit to issue final findings. LPA met with Moche Davis, Administrator and explained the purpose of the visit. LPA requested relevant documents and interviewed 3 staff, Administrator and Licensee on 09/08/2022. LPA interviewed C1’s family on 9/07/22 and C1’s Service Coordinator on 09/01/2022 and 10/27/2022.

On the allegation: Staff are not providing adequate support to address resident’s needs. Interviews with Tri-Counties Regional Center staff revealed that on multiple occasions, the facility Licensee was offered extra staff support and hours to assist Resident 1 (R1) with activities. Resident 1 enjoys hiking and being outdoors yet the facility refused to take R1 on outings or support their interests because it didn’t align with the other residents’ interests. Interviews also revealed R1’s family members take R1 out to hike and do other activities in the community regularly, and the family and Tri-Counties hired a private staff to come for a few hours on the weekend to take R1 hiking.
Continued on 9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Jeannette Olson
LICENSING EVALUATOR SIGNATURE:

DATE: 10/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2022
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-20220831122413
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 4
FACILITY NUMBER: 425801936
VISIT DATE: 10/28/2022
NARRATIVE
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When offered more staff hours, the Licensee stated they don’t have enough staff to provide those activities and hours to R1. Licensee also stated that R1 requires a higher level of care than the facility can provide due to the elopement and wanting outdoor activities, and wants to evict R1 on that basis. When interviewed, the Licensee stated they don’t feel comfortable having R1 in the facility due to elopement behaviors and want them relocated. LPA explained that the facility must meet R1’s needs. R1 has a behaviorist, but according to staff interviews, the behaviorist has not provided staff with strategies to help curb R1’s elopement and behaviors. LPA encouraged the Licensee to utilize all resources available to work on R1’s eloping behaviors, and to support R1’s preferred activities, including the one-on-one staff offered by Tri-Counties Regional Center. On 10/27/2022 LPA received an update that Tri-Counties Regional Center approved 292 hours per month of 1-on-1 support for R1 effective 10/1/2022. Tri-Counties stated that as of 10/27/2022 the facility has yet to hire someone or give R1 those hours. Documentation and interviews with staff revealed staff assist R1’s needs with assistance of medications, and prompting/set-up for showering and prompting using the bathroom. R1’s Individual Program Plan indicates R1 requires constant supervision as R1 occasionally tries to elope. R1’s Appraisal/Needs and Services Plan states at times R1 will become physically aggressive, yell at others, and/or attempt to elope when they are unhappy with their current environment or situation. The Plan states staff at Bauer will assist with implementation of the Plan. However, staff interviewed stated there has been no training or support to redirect R1 when R1 elopes/attempts to elope, and they struggle with supporting R1 with behaviors. R1’s Individual Program Plan indicates R1 is active and it is important to be able to exercise on a consistent basis, and R1 will be provided with opportunities to exercise every day and have staff that can keep up with R1. R1’s Appraisal/Needs and Services Plan states R1 will participate in exercise to maintain optimal health. The Plan states staff at Bauer will assist with implementation of the Plan. Interviews revealed staff do not assist R1 with exercise every day. Additionally, during the investigation, LPA discovered the facility was restricting visitation for R1 by not allowing R1 to have overnight/weekend visits with family, and cited COVID-19 restrictions and behaviors were the reason. LPA notified Administrator and Licensee on the 9/8/2022 visit that COVID-19 visitation restrictions were lifted and they cannot prevent R1 from having visitation, as long as they follow current guidance. Based on documentation and interviews, staff are not supporting R1 with needs listed in their Plans. Therefore the allegation is deemed Substantiated at this time.

On the allegation: Facility is unlawfully evicting resident. Interviews revealed that the facility gave Tri-Counties Regional Center and Resident 1’s family a 30-day eviction notice dated 08/28/2022 and did not send a copy to Licensing, which is required per regulation 85068.5. Continued on 9099-C
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Jeannette Olson
LICENSING EVALUATOR SIGNATURE:

DATE: 10/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 29-AS-20220831122413
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 4
FACILITY NUMBER: 425801936
VISIT DATE: 10/28/2022
NARRATIVE
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During the initial complaint visit on 9/8/2022, LPA sent the facility the Eviction procedures outlined in 85068.5 and the facility resubmitted the eviction letter to Licensing, Tri-Counties Regional Center, and R1's family on 09/12/2022. The eviction letter stated due to Resident 1’s behaviors, the facility could not support R1 any longer. Licensing found the eviction to be invalid and officially denied the eviction due to R1 having these same behaviors when R1 was admitted. Based on interviews and record review the allegation is deemed Substantiated at this time.

Pursuant to Title 22 Division 6 Chapter 8 of the CA Code of Regulations, the following deficiencies were cited (refer to LIC 809-D):

Exit interview conducted, report and appeal rights were emailed to Administrator and Licensee.
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Jeannette Olson
LICENSING EVALUATOR SIGNATURE:

DATE: 10/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 29-AS-20220831122413
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 4
FACILITY NUMBER: 425801936
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/28/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/04/2022
Section Cited
CCR
85078(a)(1)
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85078 Responsibility for Providing Care and Supervision (a)...the following shall apply: (1)The licensee shall provide those services identified in the client's needs and services plan as necessary to meet the client's needs.
This requirement was not met as evidenced by:
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The administrator agreed to submit a signed written statement of understanding and acknowledgement of section 85078. Administrator has agreed to utilize additional resources to meet R1’s needs and submit a plan to meet these needs to CCL by 11/04/2022..
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Based on interview and record review, the licensee did not comply with the section cited above in that staff did not support R1’s needs as outlined in their care plans, which posed a potential health, safety and personal rights risk to persons in care.
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Type B
10/28/2022
Section Cited
CCR
85068.5(e)
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85068.5 (e) Eviction Procedures. A written report of any eviction processed in accordance with (a) above shall be sent to the licensing agency within five days of the eviction.
This requirement was not met as evidenced by:
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The licensee submitted the eviction notice to Licensing on 9/12/2022. Licensing subsequently denied the eviction because it did not meet 85068.5(a)(1-5) and the licensee rescinded the notice. The POC cleared during visit.
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Based on interview and record review, the licensee did not comply with the section cited above when issuing R1’s eviction, which poses a potential health, safety and personal rights risk to persons 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.
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Jeannette Olson
LICENSING EVALUATOR SIGNATURE:

DATE: 10/28/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2022
LIC9099 (FAS) - (06/04)
Page: 4 of 4