360902129-10-1-2020-18-AS-EMAN-BUTUCY-20201028152844

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 360902129
Report Date: 10/01/2020
Date Signed: 10/01/2020 02:14:00 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
06/03/2020 and conducted by Evaluator Naisha Kendrix

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20200603141816

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: 87	DATE:	10/01/2020
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	James Braswell, Administrator		TIME COMPLETED:	12:30 PM

ALLEGATION(S):

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Facility staff engage in verbal altercation with resident.

Facility staff yelled at resident.

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 conducted six interviews. All of the interviews conducted revealed that resident one (R1) was in the kitchen area getting ice from the ice machine. The staff observed R1 and informed them that residents were not allowed to reach into the ice machine without gloves or an ice scoop and that the staff would assist them. R1 then began yelling at staff, calling them inappropriate names, and accusing them of being racist. Staff walked away from R1.

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: 10/01/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/01/2020

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-20200603141816

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: 10/01/2020

NARRATIVE

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Three of the six interviews stated that R1 discussed the ice incident with Administrator Tammy Chavez the next day where R1 was observed yelling and calling the administrator names. Interviews confirmed the administrator did not yell or argue with R1. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

An exit interview was conducted where this report was reviewed with the administrator. The administrator will review the report and return the signed 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: 10/01/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/01/2020

LIC9099 (FAS) - (06/04)

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