360900100-12-21-2021-18-AS-EMAN-CCSQWA-20220323123137

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 360900100
Report Date: 12/21/2021
Date Signed: 12/21/2021 11:23:58 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
12/13/2021 and conducted by Evaluator Melody Brown

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20211213142702

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: 45	DATE:	12/21/2021
		UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Linda Woofter		TIME COMPLETED:	11:30 AM

ALLEGATION(S):

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Masks are not being required.
Staff are not protecting residents from COVID.
Facility not reporting positive covid cases.

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPAs) Melody Brown and Rohit Lama made an unannounced visit to commence a complaint investigation as well as to deliver findings for the allegations listed above. LPAs met with Administrator Linda Woofter. The investigation consisted of file review, interviews with staff and residents as well as LPA Brown and Lama’s observation.

The investigation, which consisted of interviews and document reviews revealed the following:
LPAs Brown and Lama observed temperature checks at the entrance area of the facility, visitors were asked the screening questions, visitors vaccination status and all staff are wearing masks. In addition, LPAs Brown and Lama observed Covid-19 signages throughout the facility, sufficient hand sanitizers located in the common areas of the facility and social distancing are being implemented. During the investigation, LPAs Brown and Lama did not obtain evidence to corroborate the allegation.
The first allegation indicates that masks are not required. During the investigation, LPAs Brown and Lama did not obtain evidence to corroborate the allegation. *** continuation on LIC 9099C***

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 248-0337
LICENSING EVALUATOR NAME: Melody Brown	TELEPHONE: 951-897-2187
LICENSING EVALUATOR SIGNATURE:	DATE: 12/21/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/21/2021

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 18-AS-20211213142702

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: 12/21/2021

NARRATIVE

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LPAs Brown and Lama interviewed 6 residents and 5 staffs. 6 out of 6 residents stated that staff always wore masks while at the facility. LPAs Brown and Lama interviewed 5 staff. 5 out of 5 staff stated that they always wear mask and they were provided the necessary personal protective equipment (PPE).

The second allegation indicates that staff are not protecting residents from Covid. Interviews with staff and residents also indicated that staff are protecting residents from Covid by following appropriate Covid Protocol. 6 out of 6 residents stated that facility staff follows proper Covid protocol. LPAs Brown and Lama interviewed 5 staffs. 5 out of 5 staff stated that they are following proper Covid protocol to protect residents in care. They sanitized frequently touched areas, wash hands and practice social distancing. In addition, 5 out of 5 staff also indicated that they were provided the necessary personal protective equipment (PPE) and were provided training on donning and doffing PPE and covid prevention.

The third allegation indicates that facility’s not reporting positive covid cases. Interviews with staff and residents indicated that facility is reporting positive covid cases. 5 out of 5 staff reported that S1 reports positive cases to appropriate authorities. 6 out of 6 residents reported that they believed that the facility reports Covid positive cases to appropriate authorities.

Based on the information obtained and observation, there is not enough evidence to state masks are not required (allegation #1), staff are not protecting residents from Covid (allegation #2) and facility’s not reporting positive covid cases (allegation #3). Although the 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 unsubstantiated at this time.

An exit interview was conducted, and a copy of this report (LIC 9099) was provided to Administrator Linda Woofter.

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 248-0337
LICENSING EVALUATOR NAME: Melody Brown	TELEPHONE: 951-897-2187
LICENSING EVALUATOR SIGNATURE:	DATE: 12/21/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/21/2021

LIC9099 (FAS) - (06/04)

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