360902129-9-14-2022-56-AS-KCLS-CKTRVA-20221103132110

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 360902129
Report Date: 09/14/2022
Date Signed: 09/14/2022 04:09:49 PM

Unsubstantiated

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
, CA 92507

This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/06/2022 and conducted by Evaluator Bernadette Allen

COMPLAINT CONTROL NUMBER: 56-AS-20220906134157

FACILITY NAME:	BRASWELL'S CHATEAU VILLA		FACILITY NUMBER:	360902129
ADMINISTRATOR:	MELANIE NIEZ		FACILITY TYPE:	740
ADDRESS:	620 E. HIGHLAND AVENUE		TELEPHONE:	(909) 793-0433
CITY:	REDLANDS	STATE: CA	ZIP CODE:	92374
CAPACITY:	156	CENSUS: 101	DATE:	09/14/2022
		UNANNOUNCED	TIME BEGAN:	01:45 PM
MET WITH:	Melanie Niez -Administrator		TIME COMPLETED:	04:15 PM

ALLEGATION(S):

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Staff not providing resident with meals in a timely manner.
Resident’s shower is dirty.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Bernadette Allen conducted an unannounced visit to initiate a complaint investigation for the allegations above. LPA Allen met with Melanie Niez who was informed of the purpose of the visit.

Allegation #1-Staff not providing resident with meals in a timely manner.

During the investigation LPA Allen observed that there was a current menu avaliable for review.LPA observed sufficient food supplies to met the needs of those in care. LPA also interviewed (4) four residents and (5) five staff members who stated meals are being served meals by staff in a timley manner.

Continued.....

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Karen Clemons	TELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Bernadette Allen	TELEPHONE: 951-897-2618
LICENSING EVALUATOR SIGNATURE:	DATE: 09/14/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2022

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 56-AS-20220906134157

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
, CA 92507

FACILITY NAME: BRASWELL'S CHATEAU VILLA	FACILITY NUMBER: 360902129
	VISIT DATE: 09/14/2022

NARRATIVE

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Allegation # 2- resident's shower is dirty.

During LPA Allen interviews and observations the shower room which is available for all residents appeared to be safe, sanitary and in good repair during visit.

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are Unsubstantiated at this time.

An exit interview was conducted where this report was discussed and provided to Melanie Niez.

SUPERVISOR'S NAME: Karen Clemons	TELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Bernadette Allen	TELEPHONE: 951-897-2618
LICENSING EVALUATOR SIGNATURE:	DATE: 09/14/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2022

LIC9099 (FAS) - (06/04)

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