360902129-10-21-2021-18-AS-DMUN-C8JTQ3-20211107135514

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 360902129
Report Date: 09/21/2021
Date Signed: 10/21/2021 04:32:38 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
08/13/2021 and conducted by Evaluator Elecia Weathersby

COMPLAINT CONTROL NUMBER: 18-AS-20210813123312

FACILITY NAME:	BRASWELL'S CHATEAU VILLA		FACILITY NUMBER:	360902129
ADMINISTRATOR:	JAMES BRASWELL		FACILITY TYPE:	740
ADDRESS:	620 E. HIGHLAND AVENUE		TELEPHONE:	(909) 793-0433
CITY:	REDLANDS	STATE: CA	ZIP CODE:	92374
CAPACITY:	156	CENSUS: 86	DATE:	09/21/2021
		UNANNOUNCED	TIME BEGAN:	11:30 AM
MET WITH:	Licensee, Jim Braswell		TIME COMPLETED:	03:37 PM

ALLEGATION(S):

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9

Staff will not allow resident to leave their room
Staff will not allow resident to leave the facility

INVESTIGATION FINDINGS:

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Licensing Program Analyst's (LPA) Elecia Weathersby made an unannounced visit to the facility for the purpose of investigating complaints regarding the above allegations. LPA met with facility Licensee, Jim Braswell and explained the purpose of the visit. Below is a summary of the findings of the investigation:

Allegation #1: Staff will not allow resident to leave their room
LPA witnessed R1 returning from a outing via OMNI Access. LPA interviewed staff and R1 regarding the allegation. R1 confirmed that R1 left R1's room without interference from facility staff to pick up medication off site. Staff also denied interfering with R1 leaving the facility. Staff indicated that they only asked R1 to sign out of the facility when leaving, R1 confirmed the staffs statement.

Allegation #2: Staff will not allow resident to leave the facility
LPA witnessed R1 returning from a outing via OMNI Access. LPA interviewed staff and R1 regarding the allegation. R1 confirmed that R1 left the facility without interference from facility staff to pick up medication off site. Staff also denied interfering with R1 leaving the facility. Staff indicated that they only asked R1 to sign out of the facility when leaving, R1 confirmed the staffs statement.

Based upon interviews and information gathered, the allegation is UNFOUNDED, meaning that the allegation is false, could not have happened, or is without a reasonable basis.

A copy of this report and appeals right were reviewed with and provided to Licensee, Jim Braswell at the end of the visit.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 248-0337
LICENSING EVALUATOR NAME: Elecia Weathersby	TELEPHONE: (951) 255-9516
LICENSING EVALUATOR SIGNATURE:	DATE: 09/21/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2021

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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