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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 360900521
Report Date: 04/27/2026
Date Signed: 04/27/2026 06:08:29 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO ASC, 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
04/20/2026 and conducted by Evaluator Edith Conchas
COMPLAINT CONTROL NUMBER: 56-AS-20260420105511
FACILITY NAME:BRASWELL'S MEDITERRANEAN GARDENSFACILITY NUMBER:
360900521
ADMINISTRATOR:LYNETTE HUMPHREYFACILITY TYPE:
740
ADDRESS:12295 4TH STREETTELEPHONE:
(909) 797-1131
CITY:YUCAIPASTATE: CAZIP CODE:
92399
CAPACITY:130CENSUS: 79DATE:
04/27/2026
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Assistant Administrator, Maria Cervantes TIME COMPLETED:
06:10 PM
ALLEGATION(S):
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Staff do not answer call buttons in a timely manner
Staff inappropriately speaks to residents
INVESTIGATION FINDINGS:
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On April 27th, 2026 Licensing Program Analyst (LPA) Edith Conchas made an unannounced visit to the facility to conduct a complaint investigation regarding the above allegations. LPA explained the purpose of the visit to Assistant Administrator, Maria Cervantes. The investigation consisted of interviews with staff and residents, review of pertinent documents and a facility tour.

Staff do not answer call buttons in a timely manner
Based on staff interviews, 3 out of 6 staff revealed it takes 5-10 minutes to answer the call light, 2 out 6 staff stated they do answer in a timely manner. Resident interviews reveal 6 out of 8 residents stated yes staff answer call buttons in a timely manner. Based on interview, this allegation is UNSUBSTANTIATED.

Staff inappropriately speaks to residents
Based on staff interviews 6 out of 7 staff stated staff do not speak inapproprialy with residents. Interviews with residents reveal 7 out 8 residents stated No staff do not speak inappropriately to residents.Based on interviews, this allegation is UNSUBSTANTIATED. Continue LIC9099-A
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Edith Conchas
LICENSING EVALUATOR SIGNATURE:

DATE: 04/27/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO ASC, 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
04/20/2026 and conducted by Evaluator Edith Conchas
COMPLAINT CONTROL NUMBER: 56-AS-20260420105511

FACILITY NAME:BRASWELL'S MEDITERRANEAN GARDENSFACILITY NUMBER:
360900521
ADMINISTRATOR:LYNETTE HUMPHREYFACILITY TYPE:
740
ADDRESS:12295 4TH STREETTELEPHONE:
(909) 797-1131
CITY:YUCAIPASTATE:CAZIP CODE:
92399
CAPACITY:130CENSUS: 79DATE:
04/27/2026
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Assistant Administrator, Maria Cervantes TIME COMPLETED:
06:10 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff do not prevent residents from smoking while residents use oxygen
Staff do not observe residents for change in conditions
INVESTIGATION FINDINGS:
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Staff do not prevent residents from smoking while residents use oxygen

Interviews with staff (S) reveal 6 of 6 staff stated there is a designated area for residents (R) to smoke. Interview with S4 reveals has witnessed R11 smoking a cigarrette in their room once. Interview with R6 revealed has smoked in their room. Based on interviews, this allegations is Substantiated.

Staff do not observe residents for change in conditions.

Interview with 4 staff reveal room checks are every 1-2 hours for the residents, depending on the care. Interview with S4 stated at night and weekends there are staffing issues. Based on interviews with residents, 2 out of 10 residents reveal staff check in with them. R1 interview reveals staff will check on them every hour but staff did not check on R1 on 4/26/2026 during the night shift and it is often occurs due to short staff. R2 interview reveal staff sometimes do not checkin for a few hours and it usually occurs at night.
Continue LIC 9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Edith Conchas
LICENSING EVALUATOR SIGNATURE:

DATE: 04/27/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 56-AS-20260420105511
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: BRASWELL'S MEDITERRANEAN GARDENS
FACILITY NUMBER: 360900521
VISIT DATE: 04/27/2026
NARRATIVE
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R5 interview reveals every once in a while when staff have time they will check in. Interview with R6 stated staff will check in with R6 if they call. Based on interviews, this allegation is susbtantiated.

Based on interviews, and record review, the allegation is SUBSTANTIATED. A finding that the complaint is SUBSTANTIATED means that the allegation is valid because the preponderance of the evidence standard has been met. During today’s visit, two deficiencies were issued. An exit interview was conducted, and this report and appeal rights were discussed and provided to Assistant Administrator, Maria Cervantes
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Edith Conchas
LICENSING EVALUATOR SIGNATURE:

DATE: 04/27/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 56-AS-20260420105511
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: BRASWELL'S MEDITERRANEAN GARDENS
FACILITY NUMBER: 360900521
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/27/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/28/2026
Section Cited
CCR
87618(b)(3)(C)
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87618Oxygen Administration - Gas and Liquid (b)(3) (C) Ensuring that the use of oxygen equipment meets the following requirements:(C)Smoking shall be prohibited where oxygen is in use. This requirement is not met as evidenced by:
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Licensee will do an inservice training with staff and a reading counciling with residents on the No smoking policy inside the facility and submit a copy of the inservice training to LPA by POC date.
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Based on interviews, the licensee did not ensure residents are not smoking inside the facility, which poses an immedtiate Health, Safety or Personal Rights risk to resident in care.
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Type A
04/28/2026
Section Cited
CCR
87411(a)
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87411 Personnel Requirements - General(a)Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs... such additional staff for the provision of adequate services.This requirement is not met as evidenced by:
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Licensee will conduct an inservice to all staff regarding regular resident check ups during all shifts and will submit a copy of completion by POC date.
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Based on interviews with 2 resident interviews reveal there is no staff checks at night during night shift when are short staffed which poses an immedtiate Health, Safety or Personal Rights risk to resident in care.
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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: Karen Clemons
LICENSING EVALUATOR NAME: Edith Conchas
LICENSING EVALUATOR SIGNATURE:

DATE: 04/27/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2026
LIC9099 (FAS) - (06/04)
Page: 4 of 4