360900521-2-18-2022-18-AS-JDHS-CVGT35-20230908142144

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 360900521
Report Date: 02/18/2022
Date Signed: 02/18/2022 05:06:41 PM

Unfounded

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
03/22/2021 and conducted by Evaluator Yolanda Delgado

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20210322104401

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: 60	DATE:	02/18/2022
		UNANNOUNCED	TIME BEGAN:	04:24 PM
MET WITH:	Krista Overmyer, Med Tech		TIME COMPLETED:	05:15 PM

ALLEGATION(S):

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Facility staff removed resident's cast without guidance from a physician
Facility staff failed to seek immediate medical attention for resident
Facility handling resident's money inappropriately
Resident is not being bathed regularly

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA), Yolanda Delgado arrived to the facility, unannounced, to conclude an investigation pertaining to the listed allegations. LPA identified herself and met with MedTech Krista Overmyer. LPA discussed the purpose of the visit and the elements of the allegations.

It was reported to Community Care Licensing that Resident (R1) was injured at the facility, which required R1 to be transported and medically assessed. After the injury, facility staff contacted emergency services. X-rays on R1’s shoulder were taken. It was reported that R1 was required a cast. After interviews with staff and review of records, it was determined that R1 had to wear a splint, not a cast. Facility stated that the splint needed to be removed at times in order to be assessed for cleanliness and proper healing. It was not determined that the splint had to be removed with guidance from a physician. There were concerns that R1 was not being bathed regularly. Information obtained from staff, client interviews, and shower logs, it was deemed that R1 would refuse to be bathed regularly.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Jazmond D Harris	TELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: Yolanda Delgado	TELEPHONE: (951) 203-0337
LICENSING EVALUATOR SIGNATURE:	DATE: 02/18/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/18/2022

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-20210322104401

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: 02/18/2022

NARRATIVE

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In regards to facility handling R1’s money inappropriately, Facility Administrator stated she wrote a check out to R1, in the amount of funds available. Facility Administrator stated she provided the check to R1, but R1 wanted the check to be authorized and sent to a family member. Facility Administrator stated per guidelines, the check had to be issued and given to R1. Additional Information provided corroborated the information obtained from Facility Administrator. Thus, the allegations were deemed to be UNFOUNDED.

A finding of UNFOUNDED means that the allegations were false, could not have happened and/or is without a reasonable basis.

An exit interview was conducted, and a copy of this report was provided to Krista Overymyer.

SUPERVISOR'S NAME: Jazmond D Harris	TELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: Yolanda Delgado	TELEPHONE: (951) 203-0337
LICENSING EVALUATOR SIGNATURE:	DATE: 02/18/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/18/2022

LIC9099 (FAS) - (06/04)

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