360900521-8-24-2021-18-AS-JESL-C6ESJ3-20210831135427

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 360900521
Report Date: 08/24/2021
Date Signed: 08/24/2021 10:55:07 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
03/02/2020 and conducted by Evaluator Crystal Colvin

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20200302160747

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: 73	DATE:	08/24/2021
		UNANNOUNCED	TIME BEGAN:	10:45 AM
MET WITH:	Keely Miller - Administrator		TIME COMPLETED:	11:00 AM

ALLEGATION(S):

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Facility failed to arrange, or assist in arranging, for medical care appropriate to the conditions and needs of the resident.

Resident's conditioned worsened due to staff not meeting resident's medical needs

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Crystal Colvin arrived at the facility unannounced to deliver findings on the open complaint with the allegation(s) above. LPA Colvin met with Administrator Keely Miller and advised her of the purpose of today's visit. Below is a summary of the findings of the investigation:

Regarding allegation "Facility failed to arrange, or assist in arranging, for medical care appropriate to the conditions and needs of the resident.": Throughout the course of the investigation, LPA Colvin reviewed relevant facility records and conducted interviews with staff, resident, and outside parties whom may have information related to the allegation. LPA Colvin was unable to prove the allegation due to lack of supporting records showing that multiple doctor's appointments for the resident (R1) had been cancelled. Additionally, LPA Colvin was unable to obtain any statements that corroborated the allegation, though not all parties were available for interview. Additionally, LPA Colvin observed documents in R1's file that showed receipts and communications arranging for transportation of R1. Therefore, since LPA Colvin could not obtain supporting evidence for the allegation, the complaint is UNSUBSTANTIATED.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Joel Esquivel	TELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Crystal Colvin	TELEPHONE: (951) 204-0848
LICENSING EVALUATOR SIGNATURE:	DATE: 08/24/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2021

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-20200302160747

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: 08/24/2021

NARRATIVE

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Regarding allegation "Resident's conditioned worsened due to staff not meeting resident's medical needs": LPA Colvin interviewed informed parties for the allegation as well as reviewed records in the facility's file for R1. During LPA Colvin's investigation, LPA Colvin learned that R1 had a chronic skin condition which resulted in blisters and breakdown of the skin. Interviews confirmed that R1 had previously received treatment for this condition, for which R1 also periodically received Home Health services. Lastly, LPA Colvin was unable to obtain any statements which agreed with the allegation that R1's condition worsened due to the lack of medical care. Therefore, based on R1's documented chronic skin condition and history of requiring routine treatment, the allegation "Resident's conditioned worsened due to staff not meeting resident's medical needs" is UNSUBSTANTIATED

A finding of 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.

An exit interview was conducted with Administrator Keely Miller and a copy of this report was provided.

SUPERVISOR'S NAME: Joel Esquivel	TELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Crystal Colvin	TELEPHONE: (951) 204-0848
LICENSING EVALUATOR SIGNATURE:	DATE: 08/24/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2021

LIC9099 (FAS) - (06/04)

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