360900521-2-16-2023-18-AS-KCLS-CP62W6-20230217164502

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 360900521
Report Date: 02/16/2023
Date Signed: 02/16/2023 08:31:07 PM

Unsubstantiated

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
, CA 92507

This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/13/2021 and conducted by Evaluator Bernadette Allen

COMPLAINT CONTROL NUMBER: 18-AS-20210913091933

FACILITY NAME:	BRASWELL'S MEDITERRANEAN GARDENS		FACILITY NUMBER:	360900521
ADMINISTRATOR:	KEELY MILLER		FACILITY TYPE:	740
ADDRESS:	12295 4TH STREET		TELEPHONE:	(909) 797-1131
CITY:	YUCAIPA	STATE: CA	ZIP CODE:	92399
CAPACITY:	130	CENSUS: 71	DATE:	02/16/2023
		UNANNOUNCED	TIME BEGAN:	07:09 PM
MET WITH:	Keely Miller		TIME COMPLETED:	07:10 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Facility has bed bugs
Resident's room smells like urine
Staff are locking resident in room

INVESTIGATION FINDINGS:

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

****This is a copy of Original 9099 dated 9/20/2021, investigation conducted by LPA Jennifer Semin***

Licensing Program Analyst (LPA) Jennifer Semin arrived to the facility unannounced to initiate a complaint investigation and deliver the findings for the allegations listed above. LPA met with Administrator Keeley Miller. The investigation consisted of facility record review and interviews with relevant parties.

Regarding the first allegation, Facility has bedbugs.

The facility has a monthly contract for extermination services thru Pro-Active (a pest control company) and invoices obtained by LPA indicate that the facility was actively being sprayed for bedbugs on 8/16/2021 and 8/25/2021. Interviews with residents in the affected rooms stated they did not have bedbugs after the pest control service and staff cleaning and disinfecting. In addition to spraying, facility is discarding all linens in problem rooms as well as cleaning and treating furniture and mattresses that may be affected.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Karen Clemons	TELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Bernadette Allen	TELEPHONE: 951-897-2618
LICENSING EVALUATOR SIGNATURE:	DATE: 02/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/16/2023

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-20210913091933

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
, CA 92507

FACILITY NAME: BRASWELL'S MEDITERRANEAN GARDENS	FACILITY NUMBER: 360900521
	VISIT DATE: 02/16/2023

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

Regarding the second allegation, Resident's room smells like urine.

LPA toured the facility, going into multiple resident rooms and did not smell any urine. Staff stated some residents do urine on the carpet, but it is cleaned and disinfected immediately. Residents interviewed stated they do not smell urine in the facility.

Regarding the third allegation, Staff are locking resident in room.

LPA observed the all resident doors to have a standard privacy bedroom/bathroom doorknob that requires a key locking function on the outside with a thumb turn unlocking on the inside. Staff stated they do not lock residents in their rooms. Residents interviews stated staff do not lock them in their room. Investigation did not reveal further information to either refute or corroborate the allegation.

Based upon interviews and information gathered, and although the allegations may have happened or are 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 where this report was discussed and provided to administrator.

SUPERVISOR'S NAME: Karen Clemons	TELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Bernadette Allen	TELEPHONE: 951-897-2618
LICENSING EVALUATOR SIGNATURE:	DATE: 02/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/16/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 2