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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 360900521
Report Date: 05/04/2021
Date Signed: 05/04/2021 09:56:36 AM



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
04/07/2020 and conducted by Evaluator Javina George
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20200407113059
FACILITY NAME:BRASWELL'S MEDITERRANEAN GARDENSFACILITY NUMBER:
360900521
ADMINISTRATOR:VIRGINIA BAUERFACILITY TYPE:
740
ADDRESS:12295 4TH STREETTELEPHONE:
(909) 797-1131
CITY:YUCAIPASTATE: CAZIP CODE:
92399
CAPACITY:130CENSUS: 72DATE:
05/04/2021
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Administrator Keely Miller TIME COMPLETED:
10:00 AM
ALLEGATION(S):
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Facility staff is not according resident privacy.
Facility staff did not keep resident's information confidential.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Javina George contacted Administrator Keely Miller via telephone for the purpose of delivering findings for the allegation(s) listed above. LPA Javina George explained the purpose of the call.

The allegations were investigated by the department. The investigation consisted of a review of excerpts from the employee handbook, expectations in regards to employee and social media usage while on the clock as well as conducted various interviews.

LPA George reviewed documents that showed an unidentified individual had access to the facility. Whom shared pictures of two different residents revealing part of their face, and pictures of two different resident's names indicating which rooms that they were in on a social media site. In addition to the pictures LPA George reviewed additional footage (live recording) of staff assisting one of a resident's with using a urinal.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Joel EsquivelTELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Javina GeorgeTELEPHONE: (951) 204-7107
LICENSING EVALUATOR SIGNATURE:

DATE: 05/04/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2021
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 3
Control Number 18-AS-20200407113059
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/04/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/18/2021
Section Cited
CCR
87468.1(a)(1)
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87468 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.
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The administrator will retrain all staff on confidentiality. Proof of training will be submitted to the department by the close of business day by the POC due date indicated.
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This requirement was not met as evidenced by: Based on observation, interview and record review the licensee did not observe on more than one occasion the residents had not been afforded their privacy. This poses a potential Health, Safety or Personal Rights risk to persons in care.
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Type B
05/18/2021
Section Cited
HSC
1569.315
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Records of licensed facilities
Each residential care facility for the elderly required to be licensed pursuant to this chapter shall keep a current record of clients in the facility, including the client’s name and ambulatory status, and the name, address, and telephone number of the client’s physician and of any person or agency responsible for the care of the client. The facility shall protect the privacy and confidentiality of this information.
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 The administrator will retrain all staff on Residents and their personal rights. Proof of training will be submitted to the department by the close of business day by the POC due date indicated.
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This requirement was not met as evidenced by: Based on observation, interview and record review the licensee did not protect the privacy and confidentiality of client information on 4 different occasions. This poses a potential Health, Safety or Personal Rights risk to persons 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: Joel EsquivelTELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Javina GeorgeTELEPHONE: (951) 204-7107
LICENSING EVALUATOR SIGNATURE:

DATE: 05/04/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2021
LIC9099 (FAS) - (06/04)
Page: 3 of 3
Control Number 18-AS-20200407113059
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: 05/04/2021
NARRATIVE
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Based on observation, interview and record review LPA was able to corroborate the allegation(s). The allegation Facility staff is not according resident privacy is SUBSTANTIATED. The allegations of finding that the complaint is SUBSTANTIATED means that the allegation is valid because the preponderance of the evidence standard has been met.

Allegation #2-Facility staff did not keep resident's information confidential.
LPA reviewed pictures of two different residents that had part of their faces visible, and pictures of two different resident's names; indicating which rooms that they were in being on a social media site. The allegation Facility staff did not keep resident's information confidential is SUBSTANTIATED. The allegations of finding that the complaint is SUBSTANTIATED means that the allegation is valid because the preponderance of the evidence standard has been met.

Based on the investigation deficiencies were observed and cited according to California Code of Regulations, Title 22, Division 6 and listed on the attached LIC 9099D.

An exit interview was conducted and a copy of this report 9099C and LIC 9099D and appeal rights were provided to the Administrator Keely Miller via email. LPA George also requested for Keely to sign the report and send it back to LPA via provided email.
SUPERVISOR'S NAME: Joel EsquivelTELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Javina GeorgeTELEPHONE: (951) 204-7107
LICENSING EVALUATOR SIGNATURE:

DATE: 05/04/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 3