360900521-2-28-2023-18-AS-DMUN-CPSLPF-20230310075546

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 360900521
Report Date: 02/28/2023
Date Signed: 02/28/2023 04:27:42 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
01/21/2021 and conducted by Evaluator Tricia Danielson

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20210121081555

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:	02/28/2023
		UNANNOUNCED	TIME BEGAN:	02:45 PM
MET WITH:	Christelle Bunney, Receptionist		TIME COMPLETED:	04:35 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 Receptionist 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 bed bugs are on the resident's beds. Interview with AD Miller revealed the facility maintains an ongoing battle with bed bugs. The facility 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 reveal 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 Mullen	TELEPHONE: (951) 248-8031
LICENSING EVALUATOR NAME: Tricia Danielson	TELEPHONE: (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-20210121081555

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 as 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 bed 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 LIC811- Confidential Names list and Appeal Rights.

SUPERVISOR'S NAME: Deborah Mullen	TELEPHONE: (951) 248-8031
LICENSING EVALUATOR NAME: Tricia Danielson	TELEPHONE: (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)

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Control Number 18-AS-20210121081555

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)	1 2 3 4 5 6 7	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: The licensee did not ensure the facility was	1 2 3 4 5 6 7	The facility will submit a detailed plan of action, including 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.
	8 9 10 11 12 13 14	safe and sanitary at all times. Based on interviews conducted and records reviewed, the facility has experienced an ongoing battle with bed bugs but did not take action to mitigate bed bugs until October 2022. This poses a potential health, safety, and personal rights risk to residents in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
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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 Mullen	TELEPHONE: (951) 248-8031
LICENSING EVALUATOR NAME: Tricia Danielson	TELEPHONE: (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: 3 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
01/21/2021 and conducted by Evaluator Tricia Danielson

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20210121081555

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:	02/28/2023
		UNANNOUNCED	TIME BEGAN:	02:45 PM
MET WITH:	Christelle Bunney, Receptionist		TIME COMPLETED:	04:35 PM

ALLEGATION(S):

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Residents are not getting showered timely
Residents are being left in soiled diapers

INVESTIGATION FINDINGS:

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Licensing Program Analyst(LPA) Tricia Danielson arrived unannounced to the facility to conclude an investigation into the allegations listed above. LPA met with Receptionist Christelle Bunney and explained the purpose of the visit. Administrator Keely Miller was unavailable due to weather.
Regarding the allegation "Residents are not getting showered timely", it was alleged that residents sometimes go a week without a shower. Interviews were conducted with thirteen(13) residents. Two(2) of thirteen(13) residents interviewed reported they do not receive assistance with a shower on a regular basis or in a timely manner.
Regarding the allegation "Residents are being left in soiled diapers", it was alleged that residents are often left in soiled diapers and are not being changed timely. Interivews were conducted with thirteen(13) residents. All thirteen(13) residents interviewed reported they do not utilized diapers or they wear pull up type diapers and are able to manage them on their own.
Although the allegations may have happened or are valid, there is no preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are unsubstantiated. An exit interivew was conducted and a copy of this report was provided.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Deborah Mullen	TELEPHONE: (951) 248-8031
LICENSING EVALUATOR NAME: Tricia Danielson	TELEPHONE: (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)

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