360900100-10-14-2020-18-AS-RLAY-BUFS9K-20201016134048

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 360900100
Report Date: 10/09/2020
Date Signed: 10/14/2020 08:28:20 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/28/2020 and conducted by Evaluator Pauline Beschorner

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20200428130144

FACILITY NAME:	BRASWELLS YUCAIPA LEISURE MANOR		FACILITY NUMBER:	360900100
ADMINISTRATOR:	LINDA WOOFTER		FACILITY TYPE:	740
ADDRESS:	32195 AVENUE E		TELEPHONE:	(909) 797-1314
CITY:	YUCAIPA	STATE: CA	ZIP CODE:	92399
CAPACITY:	61	CENSUS: 47	DATE:	10/09/2020
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Linda Woofter		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Lack of supervision resulting in inappropriate interactions between resident's.
Staff yells at resident's
Facility did not maintain a comfortable temperature for resident's.
Staff did not report an incident.
Resident's paying for services they do not receive
Staff ignores resident's

INVESTIGATION FINDINGS:

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

Licensing Program Analyst (LPA) Pauline Beschorner conducted this investigation visit telephonically due to Covid-19 to conclude this agency’s investigation into the complaint allegations mentioned above. LPA spoke with Administrator Linda Woofter.

During this investigation, interviews were conducted with the Administrator, staff and residents. Resident’s (R1-R6) admission agreements were obtained and reviewed.

The first allegation states that there was a lack of supervision resulting in inappropriate interactions between residents. An interview with the Administrator revealed that R1 had stuck R1’s hand in R2’s pockets but R2 revealed that R1 did not inappropriately touch R2 in any way. Interviews with residents and staff revealed that residents and staff have never witnessed R1 inappropriate interactions with other residents. Interview with R3 stated that R1 has solicitated sex from R3 but when R3 denied wanting to have sex with R3, R1 has never asked and complied with R3’s request. Interviews with 3 of 3 staff revealed that R1 has never assaulted staff.
CONTINUED ON NEXT PAGE

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Karen Clemons	TELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Pauline Beschorner	TELEPHONE: (951) 897-7936
LICENSING EVALUATOR SIGNATURE:	DATE: 10/09/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2020

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 3

Control Number 18-AS-20200428130144

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: BRASWELLS YUCAIPA LEISURE MANOR	FACILITY NUMBER: 360900100
	VISIT DATE: 10/09/2020

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

CONTINUED FROM PAGE 1
The second allegation states that staff yell at residents. Interviews with 4 of 6 residents revealed that residents have never witnessed staff yell at the residents. Interview with R6 revealed that R6 has witnessed staff redirecting R1 to not take uneaten food out of the trash can but it was to stop R1 from taking the food out of the trash can and staff were not yelling in a authoritative manner and did not mean harm by the yelling. Interviews with 3 of 3 staff revealed that staff do not yell at the residents and staff have not witnessed peers yelling at the residents.

The third allegation alleges that facility did not maintain a comfortable temperature for residents. Interviews with 4 of 6 residents revealed that the facility is kept at a comfortable temperature. Interview with R6 revealed that R6’s room can be warm in the summer months when the sun hits that specific side of the building however, Administrator and staff have attempted to keep the facility cool including but not limiting to have the air conditioner serviced a couple times throughout the warmer months, lowered the thermostat, and educated the residents on keeping the doors of their rooms closed so that proper circulation can ventilate this specific wing of the facility. The facility has also provided residents with fans. Interviews with 2 of 3 staff revealed that the facility is kept at a comfortable temperature and residents have not complained about the temperature of the facility. Interview with S1 confirmed that residents tend to leave room doors open which does not circulate the air flow properly and causes this specific wing of the facility to be warmer when the sun hits that specific side of the building.

The fourth allegation alleges that staff did not report an incident. Interviews with 3 of 3 staff revealed that reporting procedures are consistent with trainings received. 3 of 3 staff have been trained in reporting incidents. LPA reviewed incident log and verified that the facility has been reporting incidents to CCL.

The fifth allegation alleges that residents are paying for services that they are not receiving. Interviews with 5 of 6 residents revealed that all 5 residents are happy that they are receiving all the services that the residents interviewed are paying for. LPA reviewed 6 of 6 admission agreements received and LPA verified that all residents are receiving Level I care meaning that residents are independent and able to shower and shave without the assistance of a caregiver.

CONTINUED ON NEXT PAGE

SUPERVISOR'S NAME: Karen Clemons	TELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Pauline Beschorner	TELEPHONE: (951) 897-7936
LICENSING EVALUATOR SIGNATURE:	DATE: 10/09/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2020

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 18-AS-20200428130144

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: BRASWELLS YUCAIPA LEISURE MANOR	FACILITY NUMBER: 360900100
	VISIT DATE: 10/09/2020

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

CONTINUED

The sixth allegation alleges that staff ignore residents. Interviews with 5 of 6 residents revealed that all 5 residents do not feel as if staff ignore the residents and that staff are kind. Interviews with 2 of 3 staff revealed that staff do not ignore the residents. Interview with S3 revealed that staff are very attentive to residents needs. Many times, residents will be very repetitive and ask staff the same question due to medical problems and staff will answer each time and not ignore the residents.

Although the above-mentioned allegations 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 allegations are deemed UNSUBSTANTIATED at this time.

An exit interview was conducted, and a copy of this report was reviewed with and provided to Administrator Linda Woofter, whose signature on this form confirm receipt of the above-mentioned documents.

END OF REPORT

SUPERVISOR'S NAME: Karen Clemons	TELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Pauline Beschorner	TELEPHONE: (951) 897-7936
LICENSING EVALUATOR SIGNATURE:	DATE: 10/09/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2020

LIC9099 (FAS) - (06/04)

Page: 3 of 3