360902129-1-6-2021-18-AS-EMAN-C92RGJ-20211123120050

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 360902129
Report Date: 01/06/2021
Date Signed: 01/06/2021 01:17:33 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
12/28/2020 and conducted by Evaluator Stephanie Williams

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20201228135436

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: 95	DATE:	01/06/2021
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	James Braswell		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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Facility staff are not following resident's prescribed diet
Facility staff spoke to resident in an appropriate way

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Stephanie Williams contacted the facility to initiate a complaint investigation into the above allegations via telephone due to the COVID-19 pandemic. LPA identified herself and discussed the purpose of the call with Licensee, James Braswell. The investigation consisted of interviews with residents/staff and records review.

In regards to allegation #1, facility staff are not following resident's prescribed diet, Staff #1 (S1) stated that the facility staff are providing Resident #1 (R1) with prescribed diet. S1 stated that R1 oftentimes buys their own food and has been lately refusing to eat the food provided by the facility. LPA also interviewed Staff #2 (S2) who stated that the facility accommodates prescribed diets and always allows for substitutions of meals.

In regards to allegation #2, facility staff spoke to resident in an appropriate way, LPA interviewed S1, Staff #2 (S2) and Staff #3 (S3) who all denied that staff are speaking inappropriately to staff. LPA interviewed Resident #2 (R2) who stated that some staff members speak down on the residents. LPA interviewed Resident #3 (R3)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 248-0337
LICENSING EVALUATOR NAME: Stephanie Williams	TELEPHONE: (951) 248-0317
LICENSING EVALUATOR SIGNATURE:	DATE: 01/06/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/06/2021

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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Control Number 18-AS-20201228135436

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: 01/06/2021

NARRATIVE

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who denied that facility staff speak inappropriately to residents.

Based on evidence obtained during today’s tele-visit, LPA has determined that the above allegations are UNSUBSTANTIATED; meaning that although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur.

An exit interview was conducted where this report was discussed and a copy of this report was sent to Braswell via email.

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 248-0337
LICENSING EVALUATOR NAME: Stephanie Williams	TELEPHONE: (951) 248-0317
LICENSING EVALUATOR SIGNATURE:	DATE: 01/06/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/06/2021

LIC9099 (FAS) - (06/04)

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