360900521-9-19-2024-56-AS-KCLS-DC3NUT-20241218094648

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 360900521
Report Date: 09/19/2024
Date Signed: 09/19/2024 02:50:48 PM

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
09/17/2024 and conducted by Evaluator Bernadette Allen

COMPLAINT CONTROL NUMBER: 56-AS-20240917173429

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: 84	DATE:	09/19/2024
		UNANNOUNCED	TIME BEGAN:	09:58 AM
MET WITH:	Kara Richardson Customer Liaison		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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Resident sustained unexplained burns while in care
Resident’s burns have worsened due to staff neglect

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Bernadette Allen conducted an unannounced visit to initiate and deliver findings for the mentioned allegations. LPA met with Kara Richardson Customer Liaison who was informed of the purpose of the visit and allegations.

The investigation consisted of interviews with outside parties, staff, residents, record review, and observations.
LPA Allen conducted an interview with Resident 1 (R1) who stated a staff member dropped coffee on their leg and foot while serving them breakfast in bed. R1 stated they could not recall who the staff member was, but there was a witness who could possibly confirm the allegation. LPA attempted to interview Resident 2 (R2) but they could not confirm or deny the allegations.
The interviews with staff members have stated they observed unexplained scaring thought to be burns on R1’s body but no longer believe R1 was ever burned, and the scaring has inproved since additional care has been provided.

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: 09/19/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2024

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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Control Number 56-AS-20240917173429

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: 09/19/2024

NARRATIVE

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LPA observed R1 receiving additional care from an outside party who stated R1 was not being treated for burns and documents reviewed didn’t reveal R1 was burned but was being treated for another health condition.

Based on interviews, observations and evidence gathered during the investigation, the above allegation is found to be Unsubstantiated; meaning that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur.

An exit interview was conducted and discussed with Kara Richardson Customer Liaison and a copy of the report was provided at the conclusion of the visit with appeal rights.

SUPERVISOR'S NAME: Karen Clemons	TELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Bernadette Allen	TELEPHONE: 951-897-2618
LICENSING EVALUATOR SIGNATURE:	DATE: 09/19/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2024

LIC9099 (FAS) - (06/04)

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