360900521-6-12-2023-18-AS-JDHS-CSZVZP-20230621165302

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 360900521
Report Date: 06/12/2023
Date Signed: 06/12/2023 09:23:48 AM

Substantiated

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
03/10/2021 and conducted by Evaluator Tricia Danielson

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20210310152940

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: 74	DATE:	06/12/2023
		UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Keely Miller, Administrator		TIME COMPLETED:	09:30 AM

ALLEGATION(S):

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Staff took advantage of resident's visual impairment

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPAs) Tricia Danielson and Cheryl Goodrich arrived to the facility unannounce to conclude an investigation into the allegation listed above. LPAs identified themselves and met with Administrator (AD) Keely Miller. LPAs discussed the purpose of the visit and the elements of the allegation AD Miller.
Regarding the allegation "staff took advantage of resident's visual impairment", it was alleged that Staff #1 (S1) removed their eyeglasses to hide their true identification from Resident #1 (R1) and due to R1's poor eyesight, identified themselves as someone else to R1 in an effort to get R1 to take their medication. Interview conducted with AD Miller revealed the incident did occur as alleged. Per AD Miller, R1 will not take their medications from S1. R1 has cataracts and S1 attempted to conceal their true identity from R1 by removing their own glasses to make R1 believe S1 was another staff member. R1 and S1 were unable to be interviewed. Based on LPAs observations, interviews which were conducted and record review, 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 and LIC811-Confidential Names list.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Reyna Lacey	TELEPHONE: (951) 836-3135
LICENSING EVALUATOR NAME: Tricia Danielson	TELEPHONE: (951) 565-7254
LICENSING EVALUATOR SIGNATURE:	DATE: 03/23/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/23/2021

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-20210310152940

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: 06/12/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 06/23/2023 Section Cited CCR 87468.1(a)(1)	1 2 3 4 5 6 7	Personal Rights of Residents in All Facilities- (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights:(1) To be accorded dignity in their personal relationships with staff, residents, and other persons. This requirement was not met as evidenced by:	1 2 3 4 5 6 7	AD Miller states the facility will conduct training with all staff regarding the requirement to maintain the dignity of all residents in care. Proof of training to be submitted to CCL by 5PM 6/23/2023.
	8 9 10 11 12 13 14	The licensee did not ensure the personal rights of all residents were maintained. Based on interviews conducted, R1's personal rights were violated when S1 did not accord them dignity in medication administration. 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
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: 06/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2023

LIC9099 (FAS) - (06/04)

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