360900100-9-23-2021-18-AS-EMAN-CCZW4F-20220330165727

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 360900100
Report Date: 09/22/2021
Date Signed: 09/23/2021 09:36:34 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
09/20/2021 and conducted by Evaluator Stephanie Williams

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20210920102758

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: 49	DATE:	09/22/2021
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Linda Woofter		TIME COMPLETED:	12:45 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Resident's behavior is disruptive towards other residents in care
Facility staff not enforcing house rules resulting in resident's displaying self harm

INVESTIGATION FINDINGS:

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

Licensing Program Analyst (LPA) Stephanie Williams made an unannounced visit to the facility in order to initiate a complaint investigation into the above allegations. LPA met with Administrator, Linda Woofter, and discussed the purpose of the visit. The investigation consisted of records review and interviews with staff and residents.

In regards to allegation #1, LPA Williams interviewed Staff #1 (S1) who stated that there is one resident in particular, Resident #1 (R1), who has a history of alcohol abuse and causing disruption in the facility. S1 stated that R1 leaves the facility and gets intoxicated at the local liquor store. S1 stated that R1 will return to the facility and cause disruption; however, S1 stated that the facility staff have been working with R1's physician, psychiatrist, and family members in order to address alcoholic dependence. LPA Williams reviewed R1's Medication Administration Record (MAR) in which appears that facility staff are dispensing Medication #1 (M1), a medication used for Alcoholism, appropriately. S1 stated that an assessment for R1 was conducted on 9/22/21; however, R1 did not meet the criteria for placement into memory care unit. S1 stated that the facility's

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 248-0337
LICENSING EVALUATOR NAME: Stephanie Williams	TELEPHONE: (951) 248-0317
LICENSING EVALUATOR SIGNATURE:	DATE: 09/22/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2021

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 18-AS-20210920102758

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: 09/22/2021

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

next action is to evict R1 for failure to adhere to facility rules. LPA interviewed Staff #2 (S2) and Staff #3 (S3) who both stated that R1's alcohol dependence does cause disruption within the facility; however, the facility staff are addressing R1's alcohol dependence which causes the disruptive behavior. LPA interviewed Resident #2 (R2) and Resident #3 (R3) who stated that they believe the staff is addressing R1's disruptive behavior. LPA interviewed Resident #4 (R4) who stated that R1 "is real forward" but is not disruptive. LPA interviewed Resident #5 (R5) who stated that there are residents in the facility who use drugs and alcohol which makes R5 feel unsafe. R5 stated that they are unaware if the facility is taking steps to prevent the disruptive behavior. S1 and S2 both stated that there are other residents who drink alcohol outside of the facility; however, their behavior is more attributed to their mental condition, not alcohol dependence.

In regards to allegation #2, LPA reviewed the facility's rules of resident conduct, which prohibits drugs and alcohol in the facility. LPA interviewed S1 who stated that they have confiscated alcohol and Marijuana pipes from those residents who had them in their possession. In addition, S1 stated that all residents suspected of smoking Marijuana on the premises have been given a letter reinforcing the facility's rules of resident conduct of Marijuana use. S1 stated that the facility has conducted internal investigations of suspected Marijuana use; however, S1 stated that residents deny the use of Marijuana. S1, S2, and S3 stated that the facility staff continue to monitor all residents for drug and alcohol use in the facility. S1 and S2 stated that they continue to work with resident's social workers, conservators, and physicians in order to address residents alcohol/drug use.

Based on evidence obtained during today’s visit, LPA has determined that the above allegations are UNSUBSTANTIATED; meaning that 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.

An exit interview was conducted where this report was discussed and a copy was provided to the Administrator via email.

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 248-0337
LICENSING EVALUATOR NAME: Stephanie Williams	TELEPHONE: (951) 248-0317
LICENSING EVALUATOR SIGNATURE:	DATE: 09/22/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2021

LIC9099 (FAS) - (06/04)

Page: 2 of 2