360900100-7-2-2026-56-AS-NBRN-DVRUZ9-20260707160106

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 360900100
Report Date: 07/02/2026
Date Signed: 07/02/2026 02:59:49 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO ASC, 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
06/24/2026 and conducted by Evaluator Edith Conchas

COMPLAINT CONTROL NUMBER: 56-AS-20260624102926

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: 55	DATE:	07/02/2026
		UNANNOUNCED	TIME BEGAN:	12:50 PM
MET WITH:	MedTech Supervisor Krystal Tarango		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Facility staff did not provide adequate supervision, resulting in a resident eloping from the facility.

INVESTIGATION FINDINGS:

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On 7/2/2026 Licensing Program Analysts (LPA) Edith Conchas made an unannounced visit to the facility to deliver the findings of the above allegation. LPA explained the purpose of the visit to the MedTech supervisor, Krystal Tarango. The investigation consisted of file review, interviews and observation.

Allegation Facility staff did not provide adequate supervision, resulting in a resident eloping from the facility.

Interview with staff and witnesses reveal the resident eloped from the doctors office. Interviews with witness 3 (W3) revealed that Resident 1 (R1) had multiple medical appointments and was scheduled for pickup at approximately 1:30 p.m. Interviews with w1, w2, and w3 indicated that although the outside agency provides escorts for clients who require one, R1 was not identified (flagged) as needing an escort in the initial assessment when R1 was established with InnovAge. Witness 2 stated that R1 left the clinic at approximately 11:45 a.m. Witness 3 reported that the driver arrived at the clinic at around 1:30 p.m. to pick up R1, at which time the driver informed InnovAge staff that R1 was not present.
Continue to LIC9099

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Edith Conchas
LICENSING EVALUATOR SIGNATURE:	DATE: 07/02/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2026

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 56-AS-20260624102926

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: BRASWELLS YUCAIPA LEISURE MANOR	FACILITY NUMBER: 360900100
	VISIT DATE: 07/02/2026

NARRATIVE

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Facility staff reported they do not arrange or manage escort services for residents that are on InnovAge insurance. Witness 2 reported that this was R1’s first appointment outside the InnovAge facility. Staff 2 (S2) stated that residents often return from outside appointments at varied times which is why they did not suspect the R1 was gone. Staff 1 and S2 reported they were not notified that R1 was missing until they were contacted by R1’s daughter around 3:30 PM..

During the investigation, LPA did not find evidence to corroborate the allegations due to R1 was not under the care of the facility during the time of the incident.

Based on the evidence, the allegation mentioned above is UNSUBSTANTIATED. A finding that the complaint is UNSUBSTANTIATED means although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated at this time.

An exit interview was conducted where this report was discussed and provided to MedTech Supervisor Krystal Torango.

SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Edith Conchas
LICENSING EVALUATOR SIGNATURE:	DATE: 07/02/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2026

LIC9099 (FAS) - (06/04)

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