360900521-8-27-2020-18-AS-NBRN-BSZVPR-20200831163710

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 360900521
Report Date: 08/27/2020
Date Signed: 08/27/2020 12:19:58 PM

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
07/14/2020 and conducted by Evaluator Susan Parker

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20200714161824

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: 85	DATE:	08/27/2020
		UNANNOUNCED	TIME BEGAN:	11:45 AM
MET WITH:	Keely Miller		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Facility staff neglected to clean feces and urine off the resident

INVESTIGATION FINDINGS:

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

Licensing Program Analyst Susan Parker contacted the facility via telephone, due to COVID-19, to deliver the final complaint investigation report. LPA identified herself and discussed the purpose of the call and the elements of the allegations with Administrator Keely Miller.

The investigation consisted of the following: LPA Parker interviewed Administrator Keely Miller, Caregivers #1, #2, and #3, resident #1, LPA Parker received/reviewed a letter which was sent to resident #1, staff notes, Pre-Placement Appraisal and Needs/Services Plan for resident #1.

The investigation revealed the following: It was alleged that on 7/14/20, resident #1 was allowed to sit in urine and feces for over 2 hours. LPA Parker interviewed staff #3 who was on duty when this incident was alleged to have happened. Staff #3 said she did not allow resident #1 to sit in urine/feces. Staff #3 said there are many times when resident #1 will refuse to have toileting done, or will allow staff to do toileting when the resident

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Nedra Brown	TELEPHONE: (951) 202-5776
LICENSING EVALUATOR NAME: Susan Parker	TELEPHONE: (951) 897-2187
LICENSING EVALUATOR SIGNATURE:	DATE: 08/27/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/27/2020

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-20200714161824

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: 08/27/2020

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

is ready. Staff #1 and #2 said they are not aware that resident #1 was ever allowed to sit in urine/feces for long periods of time. The Pre-Placement Appraisal says resident #1 does require assistance with personal hygiene and the caregivers said they do assist with resident #1's hygiene as the resident allows them. The needs/services appraisal says "assist with showers and ADL's as needed" and the caregivers said they are doing that. There were no witnesses to confirm the allegation.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the allegation occurred, therefore the allegation is Unsubstantiated.

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

SUPERVISOR'S NAME: Nedra Brown	TELEPHONE: (951) 202-5776
LICENSING EVALUATOR NAME: Susan Parker	TELEPHONE: (951) 897-2187
LICENSING EVALUATOR SIGNATURE:	DATE: 08/27/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/27/2020

LIC9099 (FAS) - (06/04)

Page: 2 of 2