360900521-10-27-2020-18-AS-RLAY-BUURHS-20201029130247

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 360900521
Report Date: 10/23/2020
Date Signed: 10/27/2020 12:05:24 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
03/10/2020 and conducted by Evaluator Pauline Beschorner

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20200310142717

FACILITY NAME:	BRASWELL'S MEDITERRANEAN GARDENS		FACILITY NUMBER:	360900521
ADMINISTRATOR:	VIRGINIA BAUER		FACILITY TYPE:	740
ADDRESS:	12295 4TH STREET		TELEPHONE:	(909) 797-1131
CITY:	YUCAIPA	STATE: CA	ZIP CODE:	92399
CAPACITY:	130	CENSUS: 80	DATE:	10/23/2020
		UNANNOUNCED	TIME BEGAN:	08:00 AM
MET WITH:	Keely Miller		TIME COMPLETED:	09:30 AM

ALLEGATION(S):

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Facility moved resident to another room without proper notice

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Pauline Beschorner conducted this investigation visit telephonically due to Covid-19 to conclude this agency’s investigation into the complaint allegations mentioned above. LPA spoke with Administrator Keely Miller.
During this investigation, interviews were conducted with the Administrator, staff, and residents. Resident’s (R1) admission agreement, and physician’s report were obtained and reviewed.
The allegation states the facility moved resident to another room without proper notice. Interviews with staff revealed that R1 requested to move to another room. R1 would no longer enter the room because R1 was not getting along with roommate. R1 was asked who R1 wanted to share a room with and R1 was able to choose R1’s roommate. Once R1 made the decision of who R1 wanted to share a room with the facility made the adjustment and moved R1 from room 16 to room 19 to allow R1 to feel more comfortable. LPA was unable to corroborate or refute the allegation as there was no documentation to review and resident in question was unavailable to interview.
CONTINUED ON NEXT PAGE

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Karen Clemons	TELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Pauline Beschorner	TELEPHONE: (951) 897-7936
LICENSING EVALUATOR SIGNATURE:	DATE: 10/23/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2020

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 18-AS-20200310142717

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: 10/23/2020

NARRATIVE

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CONTINUED

Although the above-mentioned allegation may have happened, or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore, the allegations are deemed UNSUBSTANTIATED at this time.

An exit interview was conducted, and a copy of this report was reviewed with and provided to Administrator Keely Miller, whose signature on this form confirm receipt of the above-mentioned documents.

SUPERVISOR'S NAME: Karen Clemons	TELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Pauline Beschorner	TELEPHONE: (951) 897-7936
LICENSING EVALUATOR SIGNATURE:	DATE: 10/23/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2020

LIC9099 (FAS) - (06/04)

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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
03/10/2020 and conducted by Evaluator Pauline Beschorner

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20200310142717

FACILITY NAME:	BRASWELL'S MEDITERRANEAN GARDENS		FACILITY NUMBER:	360900521
ADMINISTRATOR:	VIRGINIA BAUER		FACILITY TYPE:	740
ADDRESS:	12295 4TH STREET		TELEPHONE:	(909) 797-1131
CITY:	YUCAIPA	STATE: CA	ZIP CODE:	92399
CAPACITY:	130	CENSUS: 80	DATE:	10/23/2020
		UNANNOUNCED	TIME BEGAN:	08:00 AM
MET WITH:	Keely Miller		TIME COMPLETED:	09:30 AM

ALLEGATION(S):

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Staff stole resident’s belongings
Resident was not permitted privacy with their belongings.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Pauline Beschorner conducted this investigation visit telephonically due to Covid-19 to conclude this agency’s investigation into the complaint allegations mentioned above. LPA spoke with Administrator Keely Miller.

During this investigation, interviews were conducted with the Administrator, staff, and residents. Resident’s (R1) admission agreement, and physician’s report were obtained and reviewed.

The first allegation states that staff stole resident’s belongings. Interviews with staff revealed the missing items (1/2 bottle of shampoo, Dial Body Wash, 1 can of a 12-pack of Mt. Dew, and a cotton red bag with handles) R1 is speaking of were seen during the move from Room 16 to Room 19 and the bottle of shampoo and Dial Body Wash were located by staff when R1 claimed that those items were missing and shown to R1. Administrator also confirmed that the Shampoo and Dial Body Wash are provided by the facility.
CONTINUED ON NEXT PAGE

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Karen Clemons	TELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Pauline Beschorner	TELEPHONE: (951) 897-7936
LICENSING EVALUATOR SIGNATURE:	DATE: 10/23/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2020

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 18-AS-20200310142717

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: 10/23/2020

NARRATIVE

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CONTINUED

A review of facility notes for R1 revealed the facility attempted to replace the cotton red bag with handles and the 1 can of a 12-pack of Mt. Dew. R1 would not accept the items and told staff that R1 didn’t drink that and “I don’t want your bag.”

The second allegation alleges the resident was not permitted privacy with their belongings. Interviews with staff revealed that staff did not go through R1’s belongings. R1 told staff that R1 would like R1’s belongings to be moved while R1 was not in the facility as long as S1 was overseeing the move. S1 denies that staff went through R1’s belongings. LPA was unable to verify that any private items were opened by cleaning staff.

This agency has investigated the above-mentioned allegations. We have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis.

An exit interview was conducted, and a copy of this report was reviewed with and provided to Administrator Keely Miller, whose signature on this form confirm receipt of the above-mentioned documents.

SUPERVISOR'S NAME: Karen Clemons	TELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Pauline Beschorner	TELEPHONE: (951) 897-7936
LICENSING EVALUATOR SIGNATURE:	DATE: 10/23/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2020

LIC9099 (FAS) - (06/04)

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