360902129-9-29-2020-18-AS-EMAN-BU7R2L-20201008123829

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 360902129
Report Date: 09/29/2020
Date Signed: 09/29/2020 04:27:02 PM

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
04/20/2020 and conducted by Evaluator Naisha Kendrix

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20200420163927

FACILITY NAME:	BRASWELL'S CHATEAU VILLA		FACILITY NUMBER:	360902129
ADMINISTRATOR:	HEFNER, JANIE R.		FACILITY TYPE:	740
ADDRESS:	620 E. HIGHLAND AVENUE		TELEPHONE:	(909) 793-0433
CITY:	REDLANDS	STATE: CA	ZIP CODE:	92374
CAPACITY:	156	CENSUS: 87	DATE:	09/29/2020
		UNANNOUNCED	TIME BEGAN:	12:00 PM
MET WITH:	Licensee, Jim Braswell		TIME COMPLETED:	03:26 PM

ALLEGATION(S):

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Bedrooms do not accommodate comfort and safety

Staff did not pick up resident's medication

Staff failed to keep facility free from pests

INVESTIGATION FINDINGS:

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Due to the Department’s implementation, and in following current public health guidance, this report will be delivered via telephone. Licensing Program Analyst (LPA) Naisha Kendrix identified herself to the Administrator, James Braswell, and stated the reason for the call was to deliver a finding for the above allegations.

During the investigation, LPA received and reviewed a facility floor plan, an approved fire clearance, room pictures, and conducted interviews. The pictures reviewed and video tour conducted was of a double occupancy room. During the tour, LPA observed the room to be large enough to allow passage between the beds, other required items of furniture within the room, and assistant devices such as wheelchairs or walkers. Pictures provided show the required items within the room along with two residents in wheelchairs with enough room to maneuver inside the room.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Edna Musoke	TELEPHONE: (951) 248-0336
LICENSING EVALUATOR NAME: Naisha Kendrix	TELEPHONE: (951) 204-4307
LICENSING EVALUATOR SIGNATURE:	DATE: 09/29/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2020

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-20200420163927

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 CHATEAU VILLA	FACILITY NUMBER: 360902129
	VISIT DATE: 09/29/2020

NARRATIVE

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Residents interviewed could not corroborate the allegation that the bedrooms do not accommodate comfort and safety.LPA spoke to resident one (R1) regarding obtaining and ordering their medication. R1 claims the facility staff failed to pick up their medication. LPA found that R1 ordered the medication and the facility had the prescription picked up and delivered to R1 within 24 hours of being notified that the medications had been ordered. LPA reviewed R1’s medical records dated 5/1/2020 – 5/31/2020 where the prescription was provided and administered to R1 starting on 5/12/2020 at 8 PM.

LPA conducted interviews with five residents and staff. All five interviews did not corroborate the allegation of staff failed to keep the facility free of pest. Interviews that were conducted confirm there were no sightings of insects inside the rooms or in the common areas of the facility. Based on LPA’s observations and interviews which were conducted and records reviews, the preponderance of the evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED, California Code of Regulations Title 22 is being cited on the attached LIC 9099D.

An exit interview was conducted where this report was reviewed and provided to the administrator via email. The administrator will review, sign, and return the report within 24 hours of receipt.

SUPERVISOR'S NAME: Edna Musoke	TELEPHONE: (951) 248-0336
LICENSING EVALUATOR NAME: Naisha Kendrix	TELEPHONE: (951) 204-4307
LICENSING EVALUATOR SIGNATURE:	DATE: 09/29/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2020

LIC9099 (FAS) - (06/04)

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