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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 360900521
Report Date: 02/28/2023
Date Signed: 02/28/2023 04:05:08 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/22/2020 and conducted by Evaluator Tricia Danielson
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20201022150841
FACILITY NAME:BRASWELL'S MEDITERRANEAN GARDENSFACILITY NUMBER:
360900521
ADMINISTRATOR:KEELY MILLERFACILITY TYPE:
740
ADDRESS:12295 4TH STREETTELEPHONE:
(909) 797-1131
CITY:YUCAIPASTATE: CAZIP CODE:
92399
CAPACITY:130CENSUS: 71DATE:
02/28/2023
UNANNOUNCEDTIME BEGAN:
02:45 PM
MET WITH:Christelle Bunney, ReceptionistTIME COMPLETED:
04:00 PM
ALLEGATION(S):
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Facility has bed bugs
INVESTIGATION FINDINGS:
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Licensing Program Analyst(LPA) Tricia Danielson arrived unannounced to the facility to conclude an investigation into the allegation listed above. LPA met with Christelle Bunney and explained the purpose of the visit. Administrator Keely Miller was unavailable due to weather.
Regarding the allegation "Facility has bed bugs", it was alleged that although the facility sprays to mitigate the spread of bed bugs, the facility is not treated professionally by an exterminator for bed bugs. Interview with AD Miller revealed the facility maintains an ongoing battle with bed bugs. The faciltity follows an established protocol following the discovery of any new outbreaks of bed bugs which includes obtaining a doctor's order for cream, showering the resident and applying the cream, moving the resident out of the room, stripping and washing the resident's bedding, washing all the resident's clothing, spraying the room, fog bombing the room and cleaning the carpets before the resident can return to the room. Review of the facility's pest control invoices indicated the facility was treated on 10/23/2020, 11/24/2020, 12/21/2020, and 1/28/2021. The invoices revealed the facility was treated for cockroaches, rodents, flies, and spiders each time. Areas treated were the exterior (CONTINUED ON LIC9099-C)
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Deborah MullenTELEPHONE: (951) 248-8031
LICENSING EVALUATOR NAME: Tricia DanielsonTELEPHONE: (951) 565-7254
LICENSING EVALUATOR SIGNATURE:

DATE: 02/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/28/2023
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 4
Control Number 18-AS-20201022150841
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA
FACILITY NAME: BRASWELL'S MEDITERRANEAN GARDENS
FACILITY NUMBER: 360900521
VISIT DATE: 02/28/2023
NARRATIVE
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(CONTINUED FROM LIC9099)
of the building, kitchen area, and laundry room. The invoices do not indicate any resident room was treated nor was the facility itself treated for bed bugs. Additional pest control invoices were reviewed for the dates 11/10/2022, 12/9/2022, and 1/17/2023 which revealed the facility was treated for ants, earwigs, spiders, pantry pests, cockroaches, crickets, silverfish, wasps, rats, and mice each time. Areas treated were the perimeter, foundation, eaves, threshold, trash area, storage, walkways, restroom, planters, and patios of the facility. The invoices do not indicate any resident room was treated nor was the facility itself treated for bed bugs. Interview with AD Miller reported the facility has now begun to utilize heat treatments to any areas identified with bed bugs however, these treatments did not begin until 10/21/2022. A separate pest control invoice was reviewed for 10/21/2022 which indicated bed bug heat treatment was applied to rooms 45, 46, 47, 48, and 51. Records reviewed also indicated the facility purchased two(2) gallons of bed bug killer for in house use on 10/24/2022.
Based on interviews conducted, and records reviewed, the preponderance of evidence standard has been met, therefore the above allegation is found to be substantiated. California Code of Regulations (Title 22, Division 6, Chapter 8), is being cited on the attached LIC 9099 D.

An exit interview was conducted and a copy of this report was provided along with Appeal Rights.

SUPERVISOR'S NAME: Deborah MullenTELEPHONE: (951) 248-8031
LICENSING EVALUATOR NAME: Tricia DanielsonTELEPHONE: (951) 565-7254
LICENSING EVALUATOR SIGNATURE:

DATE: 02/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/28/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 18-AS-20201022150841
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA

FACILITY NAME: BRASWELL'S MEDITERRANEAN GARDENS
FACILITY NUMBER: 360900521
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/28/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/10/2023
Section Cited
CCR
87303(a)
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Maintenance and Operation: (a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement was not met as evidenced by:
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The facility will submit a detailed plan of action, to include the use of the services of an exterimator, for the mitigation of bed bugs once an outbreak is identified. All staff will be trained of the plan. Proof of the plan and training to be provided to CCL by POC due date.
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Based on interview and records reviewed, the Licensee failed to ensure the facility was sanitary at all times. Records reviewed, indicated the facility was receiving treatment for rodents and insects but not bed bugs.
This is a potential health, safety, and personal rights risk to residents.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Deborah MullenTELEPHONE: (951) 248-8031
LICENSING EVALUATOR NAME: Tricia DanielsonTELEPHONE: (951) 565-7254
LICENSING EVALUATOR SIGNATURE:

DATE: 02/28/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/28/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/22/2020 and conducted by Evaluator Tricia Danielson
COMPLAINT CONTROL NUMBER: 18-AS-20201022150841

FACILITY NAME:BRASWELL'S MEDITERRANEAN GARDENSFACILITY NUMBER:
360900521
ADMINISTRATOR:KEELY MILLERFACILITY TYPE:
740
ADDRESS:12295 4TH STREETTELEPHONE:
(909) 797-1131
CITY:YUCAIPASTATE: CAZIP CODE:
92399
CAPACITY:130CENSUS: DATE:
02/28/2023
UNANNOUNCEDTIME BEGAN:
02:45 PM
MET WITH:Christelle Bunney, ReceptionistTIME COMPLETED:
04:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff made inappropriate comments towards resident
INVESTIGATION FINDINGS:
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Licensing Program Analyst(LPA) Tricia Danielson arrived unannounced to the facility to conclude an investigation into the allegation listed above. LPA met with Christelle Bunney and explained the purpose of the visit. Administrator Keely Miller was unavailable due to weather.
Regarding the allegation "Staff made inappropriate comments towards resident", it was alleged that the staff blame residents for bed bug outbreaks and tell them, "It's your fault". Interviews were conducted with eleven(11) residents, Five(5) of eleven(11) residents interviewed reported they had experienced bed bugs in their room. Four(4) of five(5) residents interviewed who had experienced bed bugs reported they had not been told by staff that it was their fault. One(1) of the five(5) residents interviewed who had experienced bed bugs, refused to answer LPA's questions regarding the allegation. Although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated.
An exit interview was conducted and a copy of this report was provided.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Deborah MullenTELEPHONE: (951) 248-8031
LICENSING EVALUATOR NAME: Tricia DanielsonTELEPHONE: (951) 565-7254
LICENSING EVALUATOR SIGNATURE:

DATE: 02/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/28/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 4