198602885-8-10-2021-11-AS-JHAD-C5UV5U-20210813160830

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602885
Report Date: 08/04/2021
Date Signed: 08/10/2021 09:29:11 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/07/2021 and conducted by Evaluator Ulysses Coronel

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20210407130539

FACILITY NAME:	BRADDOCK HOME		FACILITY NUMBER:	198602885
ADMINISTRATOR:	DRUMMOND, MARIA		FACILITY TYPE:	740
ADDRESS:	12136 BRADDOCK DRIVE		TELEPHONE:	(310) 902-4893
CITY:	CULVER CITY	STATE: CA	ZIP CODE:	90230
CAPACITY:	4	CENSUS: 3	DATE:	08/04/2021
		UNANNOUNCED	TIME BEGAN:	02:01 PM
MET WITH:	Frances Snoddy		TIME COMPLETED:	03:45 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff neglect resulted in resident being hospitalized

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

On 08/05/2021, Licensing Program Analyst (LPA) Ulysses Coronel conducted an unannounced Complaint Visit to this facility and met with Administrator Frances Snoddy. The purpose of this visit is to deliver the findings of the investigation completed by Investigations Branch Investigator (IB) Douglas Real.

The investigation consisted of the following: On 04/08/2021 LPA Erik Brown conducted a 24-hour complaint visit to gather information for the allegation “Staff neglect resulted in resident being hospitalized.” On 05/20/2021 IB conducted record review of R1’s hospital medical records. On 06/02/2021 IB conducted an interview with the Administrator. On 06/09/2021 IB conducted interviews with caregiver S2 and residents R2 & R3. On 06/10/2021 IB conducted record reviews of R1’s resident records. On 06/26/2021 IB conducted an interview with caregiver S1. On 07/15/2021 IB conducted an interview with witness PA. 07/23/2021 IB conducted an interview with witness RMC.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Ulysses Coronel	TELEPHONE: (951) 212-8917
LICENSING EVALUATOR SIGNATURE:	DATE: 08/04/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2021

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 2

Control Number 11-AS-20210407130539

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: BRADDOCK HOME	FACILITY NUMBER: 198602885
	VISIT DATE: 08/04/2021

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

The investigation revealed the following: On 05/20/2021 hospital medical record reviews indicate that on 04/02/2021 R1 was “in no distress and had no injuries”. On 06/10/2021 doctors visit summaries indicate that on 11/10/2020 and on 02/09/2021 R1 was noted as being Cachectic (a complex syndrome associated with an underlying illness causing ongoing muscle loss that is not entirely reversed with nutritional supplementation).” On 06/10/2021 R1’s weight chart indicates that “R1 lost 12 pounds between 07/05/2020 and 03/15/2021.” On 06/02/2021 the administrator stated that “R1's appetite declined noticeably after getting their second COVID shot (on 02/13/2021)” and “R1’s medical team prescribed Ensure and that this was added to R1's diet as instructed. Despite the addition of Ensure, R1's weight did not increase.” On 6/26/2021 caregiver S1 stated that R1 continued to eat their meals and drink Ensure as well as the extra protein shakes. On 07/15/2021 witness PA stated that “R1’s change in weight is due to a decline in R1’s health and not due to neglect or lack of supervision. PA has never seen any evidence of abuse or neglect in the facility.” On 07/23/2021 witness RMC stated that: “The Regional Center was aware of R1’s decline in weight and the facility has been providing regular updates on R1’s condition.” Regarding the allegation” Staff neglect resulted in resident being hospitalized.” Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is unsubstantiated.

No deficiencies were cited. An exit interview was conducted. A copy of this report was provided to administrator Frances Snoddy and staff Briana Simpson.

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Ulysses Coronel	TELEPHONE: (951) 212-8917
LICENSING EVALUATOR SIGNATURE:	DATE: 08/04/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2021

LIC9099 (FAS) - (06/04)

Page: 2 of 2