360900521-5-25-2023-56-AS-KCLS-CT3NVG-20230623104756

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 360900521
Report Date: 05/25/2023
Date Signed: 05/25/2023 09:18:05 AM

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
02/17/2023 and conducted by Evaluator Bernadette Allen

COMPLAINT CONTROL NUMBER: 56-AS-20230217095043

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: 73	DATE:	05/25/2023
		UNANNOUNCED	TIME BEGAN:	08:20 AM
MET WITH:	Keely Miller-Administrator		TIME COMPLETED:	09:30 AM

ALLEGATION(S):

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Personal Rights Violation of a Resident
Facility is in disrepair

INVESTIGATION FINDINGS:

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

Allegation #1 Personal Rights Violation of a Resident
LPA interviewed four (4) staff members who said that the residents’ personal rights have not been violated. Staff members said that all residents are spoken to with dignity and respect. Interviews were conducted with four (4) four residents who said that staff members have not spoken or handled them in an inappropriate manner. During the interviews with residents, they were asked do they feel that their personal rights have been violated by staff members and they said no and that they are treated right/nice by the staff members.

Allegation #2-Facility is in disrepair
LPA Allen toured the facility, and it didn’t appear to be in disrepair inside or outside.

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: 05/25/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/25/2023

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-20230217095043

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: 05/25/2023

NARRATIVE

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There was an old water stain in the main hallway ceiling near the activity room going towards the residents’ rooms but there was no water leaking. Staff #1 (S1) did confirm that there was a leak in the ceiling, but it had been repaired. The thermostats were checked in (5) five bedrooms and in the main hallway and temperatures ranged from 70 -75 degree, based on LPA observations there were no health and safety concerns at this time.

Based on the interviews with staff, residents and observations of the facility inside and out the above 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.

An exit interview was conducted where this report was discussed and provided to Keely Miller with the appeal rights at the conclusion of the visit.

SUPERVISOR'S NAME: Karen Clemons	TELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Bernadette Allen	TELEPHONE: 951-897-2618
LICENSING EVALUATOR SIGNATURE:	DATE: 05/25/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/25/2023

LIC9099 (FAS) - (06/04)

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