360902129-1-10-2022-18-AS-EMAN-CBGQ4N-20220209105035

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 360902129
Report Date: 01/10/2022
Date Signed: 01/10/2022 11:24:54 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
12/01/2020 and conducted by Evaluator Stephanie Williams

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20201201154558

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: 88	DATE:	01/10/2022
		UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	James Braswell		TIME COMPLETED:	11:35 AM

ALLEGATION(S):

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Facility retained resident(s) beyond their level of care.
Facility has rodents.
Facility staff neglected to seek medical attention for resident.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Stephanie Williams made an unannounced visit to the facility in order to deliver findings for the above allegations. LPA Williams identified herself to the Administrator, James Braswell, who was also informed of the purpose of the visit. The investigation consisted of records review and interviews with staff and residents.

In regards to allegation #1, LPA Williams interviewed Staff #1 (S1), Staff #2 (S2), and Staff #3 (S3) who all denied that the facility is retaining residents beyond their level of care. S1 stated that if a resident experiences a change in condition, the resident's primary physician is notified and service plan is adjusted accordingly. S1 and S3 stated that facility staff were able to provide appropriate care for both Resident #1 (R1) and Resident #2 (R2) prior to passing.

In regards to allegation #2, S1 stated that the facility had an issue with rodents in the facility in December of 2020; however, the facility has had no issues with rodents since. S1 and Staff #4 (S4) stated that the facility

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: 01/10/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2022

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-20201201154558

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: 01/10/2022

NARRATIVE

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receives monthly extermination services. LPA Williams toured the facility and did not observe any indications that rodents were present in the facility. LPA Williams also reviewed invoices from extermination company in which it was not indicated that rodent activity was observed.

In regards to allegation #3, LPA Williams interviewed S1, S2, and S3 who all stated that facility staff was in constant contact with R1's physician for a change in condition. S2 and S3 denied that R1's physician advised facility staff to send R1 to the hospital. S2 and S3 stated that R1's physician advised the facility to make changes to R1's diet to address R1's change in condition. S2, S3, and S4 stated that R1 was experiencing a decline in health for months prior to passing. LPA Williams reviewed documentation in which it appeared that facility staff were in constant communication with R1's physician and R1 was often seen for medical attention. LPA Williams also interviewed S2 and S3 in regards to R2. Both S2 and S3 stated that R2 also experienced a decline in health and was placed on hospice by the family. S2 and S3 stated that the facility sought medical attention from the hospice agency as needed. LPA Williams reviewed documentation in which it appeared that R2 was often seen for medical attention for numerous reasons.

Based on evidence obtained during today’s visit, LPA has determined that the above allegation is 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.

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 248-0337
LICENSING EVALUATOR NAME: Stephanie Williams	TELEPHONE: (951) 248-0317
LICENSING EVALUATOR SIGNATURE:	DATE: 01/10/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2022

LIC9099 (FAS) - (06/04)

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