360900521-2-9-2024-56-AS-KCLS-D2WQKS-20240229111446

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 360900521
Report Date: 02/09/2024
Date Signed: 02/09/2024 01:57:49 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 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
02/02/2024 and conducted by Evaluator Magda Malcore

PUBLIC

COMPLAINT CONTROL NUMBER: 56-AS-20240202150207

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: 80	DATE:	02/09/2024
		UNANNOUNCED	TIME BEGAN:	08:50 AM
MET WITH:	Keely Miller, Administrator		TIME COMPLETED:	08:57 AM

ALLEGATION(S):

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Staff put poison in residents food
Staff put animal feces in residents food
Due to lack of supervision, resident was hit by another resident

INVESTIGATION FINDINGS:

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**This is an Admended report****
Licensing Program Analyst (LPA) Magda Malcore conducted an unannounced complaint visit to the facility. LPA met with Keely Miller, Administrator and discussed the purpose of the visit.
Regarding the allegations, staff put poison in residents’ food and staff put animal feces in residents’ food. LPA toured the kitchen and did not observe toxins stored in food areas. Staff interviewed deny putting poison and animal feces in residents' food. Six (6) residents interviewed stated they have not had food poisoning and have not witnessed staff put feces in residents’ food.
Regarding the allegation, Lack of supervision resulted in resident being hit by another resident. It is alleged that a resident was hit by another resident and staff did not intervene. Staff interviews reveal, staff do intervene when they witness any altercations between residents. Five (5) out of (6) residents interviewed deny witnessing a resident being hit and staff not intervening.
Based on interviews and pertinent record review, there is not a preponderance of evidence to prove the alleged violations did or did not occur; therefore the above allegations are Unsubstantiated;
An exit interview was conducted where this report was discussed, and a copy was provided to Administrator Miller at the conclusion of the visit.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Karen Clemons	TELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Magda Malcore	TELEPHONE: 951-248-0316
LICENSING EVALUATOR SIGNATURE:	DATE: 02/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2024

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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