360900521-12-28-2022-56-AS-KCLS-CPKTN7-20230303135214

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 360900521
Report Date: 12/28/2022
Date Signed: 12/28/2022 04:26:17 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
12/22/2022 and conducted by Evaluator Bernadette Allen

COMPLAINT CONTROL NUMBER: 56-AS-20221222140837

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: 77	DATE:	12/28/2022
		UNANNOUNCED	TIME BEGAN:	12:55 PM
MET WITH:	Keely Miller Administrator		TIME COMPLETED:	04:45 PM

ALLEGATION(S):

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Resident became severely dehydrated while in care
Staff failed to provide resident food

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPA) Bernadette Allen made an unannounced visit to the facility for the purpose of initiating and delivering findings on the complaints above. LPA met with Keely Miller Administrator who was informed of the purpose of my visit and the allegations above.

LPA conducted interviews and reviewed Resident (R1) file and at one point would feed themself without assistance. (R1) level of care has changed and has been feed by staff members to ensure that the resident is not deprived of food and liquids. LPA observed that the resident had been feed lunch and interviews conducted it was confirmed the resident is currently being feed and given water by staff members throughout the day.

Based on the investigation, the above finding is Unsubstantiated. A finding of unsubstantiated means although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur.

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: 12/28/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/28/2022

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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