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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 360902129
Report Date: 05/12/2023
Date Signed: 05/12/2023 09:33:12 AM

Unfounded


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA
This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/03/2020 and conducted by Evaluator Tricia Danielson
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20201103101606
FACILITY NAME:BRASWELL'S CHATEAU VILLAFACILITY NUMBER:
360902129
ADMINISTRATOR:JAMES BRASWELLFACILITY TYPE:
740
ADDRESS:620 E. HIGHLAND AVENUETELEPHONE:
(909) 793-0433
CITY:REDLANDSSTATE: CAZIP CODE:
92374
CAPACITY:156CENSUS: 91DATE:
05/12/2023
UNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Melanie Niez, AdministratorTIME COMPLETED:
09:45 AM
ALLEGATION(S):
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9
Facility staff failed to pick up resident after a medical appointment
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs) Tricia Danielson and Janette Romero arrived unannounced to the facility to conclude an investigation into the allegation listed above. LPA met with Adminstrator Melanie Niez and explained the purpose of the visit.
Regarding the allegation "Facility staff failed to pick up resident after a medical appointment", it was alleged that the facility did not ensure Resident #1(R1) was provided transportation back to the facility from an appointment at a hospital on the afternoon of November 3, 2020. Interviews with facility staff revealed R1 was not picked up by their insurance transportation service as planned following their appointment and after being contacted by the hospital late that night, a facility staff member picked R1 up and returned them to the facility at 11:30 PM.
This agency has investigated the complaint alleging "Facility staff failed to pick up resident after a medical appointment". We have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis.
An exit interview is conducted and a copy of this report was provided along with LIC811- Confidential Names list.
Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Deborah MullenTELEPHONE: (951) 248-8031
LICENSING EVALUATOR NAME: Tricia DanielsonTELEPHONE: (951) 565-7254
LICENSING EVALUATOR SIGNATURE:

DATE: 05/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA
This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/03/2020 and conducted by Evaluator Tricia Danielson
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20201103101606

FACILITY NAME:BRASWELL'S CHATEAU VILLAFACILITY NUMBER:
360902129
ADMINISTRATOR:JAMES BRASWELLFACILITY TYPE:
740
ADDRESS:620 E. HIGHLAND AVENUETELEPHONE:
(909) 793-0433
CITY:REDLANDSSTATE: CAZIP CODE:
92374
CAPACITY:156CENSUS: 91DATE:
05/12/2023
UNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Melanie Niez, AdministratorTIME COMPLETED:
09:45 AM
ALLEGATION(S):
1
2
3
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5
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8
9
Resident is not receiving adequate care at the facility
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs) Tricia Danielson and Janette Romero arrived unannounced to the facility to conclude an investigation into the allegation listed above. LPA met with Adminstrator Melanie Niez and explained the purpose of the visit. Regarding the allegation "Resident is not receiving adequate care at the facility", it was alleged that the facility failed to realize Resident #1(R1) had not returned to the facility following an appointment at a hospital on the afternoon of November 3, 2020. Interviews with facility staff as well as R1 revealed R1 was not picked up by their insurance transportation service following their appointment as planned. Interviews also revealed the facility did not realize R1 had not returned from the appointment until several hours after the end of the appointment and only after being contacted by the hospital R1 had been at. Interviews with both R1 and staff revealed R1 was not picked up from the hospital until approximately 11:30 PM on November 3, 2020. Interview with R1 revealed they did not have the means to phone the facility or the insurance transportation to be picked up. Based on interviews conducted, the preponderance of evidence standard has been met, therefore the above allegation is found to be substantiated. California Code of Regulations (Title 22, Division 6, Chapter 8), are being cited on the attached LIC 9099 D. An exit interview is conducted and a copy of this report was provided along with Appeal Rights and LIC811- Confidential Names list.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Deborah MullenTELEPHONE: (951) 248-8031
LICENSING EVALUATOR NAME: Tricia DanielsonTELEPHONE: (951) 565-7254
LICENSING EVALUATOR SIGNATURE:

DATE: 05/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 18-AS-20201103101606
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA

FACILITY NAME: BRASWELL'S CHATEAU VILLA
FACILITY NUMBER: 360902129
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/12/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/19/2023
Section Cited
CCR
87464(f)(1)
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Basic Services- (f) Basic services shall at a minimum include: (1) Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code section 1569.2(c).
This requirement was not met as evidenced by:
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The licensee will draft and implement a procedure to verify the status of all residents who have signed out to attend outside appointments or activities. Pr00f of POC to be provided to LPA by POC due date.
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The licensee did not provide basic services for R1. Based on interviews conducted, the licensee failed to provide care and supervision by being unaware R1 had failed to return to the facility following an appointment. This poses a potential health, safety, and personal rights risk to residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Deborah MullenTELEPHONE: (951) 248-8031
LICENSING EVALUATOR NAME: Tricia DanielsonTELEPHONE: (951) 565-7254
LICENSING EVALUATOR SIGNATURE:

DATE: 05/12/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 3