360900521-6-18-2020-18-AS-EMAN-BQTQ86-20200622115613

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 360900521
Report Date: 06/10/2020
Date Signed: 06/18/2020 09:00:56 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
12/06/2019 and conducted by Evaluator Robbie Johnson

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20191206102609

FACILITY NAME:	BRASWELL'S MEDITERRANEAN GARDENS		FACILITY NUMBER:	360900521
ADMINISTRATOR:	VIRGINIA BAUER		FACILITY TYPE:	740
ADDRESS:	12295 4TH STREET		TELEPHONE:	(909) 797-1131
CITY:	YUCAIPA	STATE: CA	ZIP CODE:	92399
CAPACITY:	130	CENSUS: 86	DATE:	06/10/2020
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Keely Miller, Administrator		TIME COMPLETED:	10:30 AM

ALLEGATION(S):

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Staff failed to address resident's changing condition
Staff refused to seek resident medical help
Staff harass resident

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Robbie Johnson contacted the facility via telephone to deliver findings regarding the above allegations due to covid-19. LPA identified herself and discussed the purpose of the call and the elements of the above allegation with Administrator Keely Miller.

Allegation #1 staff failed to address residents changing condition. Interviews with staff revealed that resident R1 was provided care based on R1's needs. Interviews with resident R1 did not reveal that R1's medial needs were not met. LPA could no corroborate that the facility failed to address residents needs. The allegation is therefore UNSUBSTANTIATED.

Allegation #2 staff refused to seek resident medical help. Interviews with resident R1 did not reveal that staff refused to seek medical attention. LPA could find no evidence that R1 was in need of medical help in which the staff did not provide. The allegation is UNSUBSTANTIATED.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: Robbie Johnson	TELEPHONE: (951) 248-0304
LICENSING EVALUATOR SIGNATURE:	DATE: 06/10/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2020

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-20191206102609

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: BRASWELL'S MEDITERRANEAN GARDENS	FACILITY NUMBER: 360900521
	VISIT DATE: 06/10/2020

NARRATIVE

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Allegation #3 staff harass resident. Interviews with R1 did not reveal that staff harassed the resident. Staff interviews revealed that R1 was not harassed. LPA could find no evidence that R1 was harassed. The allegation is UNSUBSTANTIATED. A finding that the complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged abuse occurred.

A copy of this report was discussed with and provided to the Administrator

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: Robbie Johnson	TELEPHONE: (951) 248-0304
LICENSING EVALUATOR SIGNATURE:	DATE: 06/10/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2020

LIC9099 (FAS) - (06/04)

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