360900521-2-9-2023-56-AS-KCLS-CR7TMB-20230424145049

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 360900521
Report Date: 02/09/2023
Date Signed: 02/09/2023 01:15:37 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
11/23/2022 and conducted by Evaluator Bernadette Allen

COMPLAINT CONTROL NUMBER: 56-AS-20221123134303

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: 70	DATE:	02/09/2023
		UNANNOUNCED	TIME BEGAN:	11:50 AM
MET WITH:	Keely Miller Administrator		TIME COMPLETED:	01:30 PM

ALLEGATION(S):

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Facility staff did not ensure that resident's room was clean.
Facility staff did not meet resident's incontinence needs.
Facility staff did not ensure that resident had clean linens.
Facility staff did not ensure resident had clean water to drink.
Facility staff did not ensure resident was regularly observed for changes in physical functioning.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA)Bernadette Allen arrived at the facility unannounced to initiate a complaint investigation and deliver the findings for the allegations listed above. LPA met with Administrator Keely Miller.

The investigation consisted of file review, observations, and interviews with six (6) staff members and nine (9) residents. The nine (9) residents said that their rooms are cleaned daily by them or the staff. The residents were asked how often does the staff change their linens and they said once a week or more if needed. The resident in question was interviewed with the assistance of (S1) who translated the interview with (R1) who said that their linens are changed weekly or as needed, their incontinence needs are always met, and they always have clean water to drink. During the visit LPA observed that (R1) had clean drinking water on the side of their bed, there was clean linen on the bed and another staff member came to assist the resident with their grooming needs. LPA visited six (6) rooms which were clean and free of odors.

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: 02/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2023

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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Control Number 56-AS-20221123134303

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: 02/09/2023

NARRATIVE

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During the interview with the 6 staff members said that the residents rooms are cleaned daily and more if an accident occurs. The residents incontinence needs are met by checking on them throughout the day 2-3 times and the linen is changed at least once a week unless the resident has an accident that requires the linen to be changed more.

Staff said that residents are always provided clean water to drink and during the visit LPA did observe several residents throughout the facility with cups of water. Staff were asked about the physical changes in residents and they said that they are to notify the nurse or Medtech and note what those changes are.

Based on the interview conducted with staff members, residents, record review and observations regarding the allegations are found to be 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.

SUPERVISOR'S NAME: Karen Clemons	TELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Bernadette Allen	TELEPHONE: 951-897-2618
LICENSING EVALUATOR SIGNATURE:	DATE: 02/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2023

LIC9099 (FAS) - (06/04)

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