360902129-7-18-2023-56-AS-EMAN-CU4RJF-20230726130353

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 360902129
Report Date: 07/18/2023
Date Signed: 07/18/2023 10:49:27 AM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 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
11/16/2022 and conducted by Evaluator Ryan Gardner

PUBLIC

COMPLAINT CONTROL NUMBER: 56-AS-20221116170954

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: 96	DATE:	07/18/2023
		UNANNOUNCED	TIME BEGAN:	09:20 AM
MET WITH:	Melanie Niez- Administrator		TIME COMPLETED:	11:00 AM

ALLEGATION(S):

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Facility staff did not keep the home free from odor.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Ryan Gardner made an unannounced visit to the facility to conclude and issue findings for the investigation that was initiated on 11/18/2022. LPA stated the purpose of the visit and was granted entry and met with Administrator Melanie Niez.

The investigation consisted of interviews with facility staff, interviews with residents, and a review of facility records.

For allegation, Facility staff did not keep the home free from odor: It was alleged that the facility smells like urine and bowel movement.

During interviews with residents, the residents stated that the facility does smell like urine and bowel movement. The residents smell urine and bowel movement in the main areas and hallways of the facility, as well as smelling the odor in their bedrooms on the flooring and carpet.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 248-8222
LICENSING EVALUATOR NAME: Ryan Gardner	TELEPHONE: (951) 836-3180
LICENSING EVALUATOR SIGNATURE:	DATE: 07/18/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2023

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 11

Control Number 56-AS-20221116170954

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: BRASWELL'S CHATEAU VILLA	FACILITY NUMBER: 360902129
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/18/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 08/08/2023 Section Cited CCR 87303(a)	1 2 3 4 5 6 7	87303. Maintenance and Operation (a)The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors.	1 2 3 4 5 6 7	The licensee has agreed to read regulation 87303 entirely and send LPA a self-certified letter that the regulation was read and understood. The licensee has agreed to contact and hire a floor and carpet cleaning company to clean the facility.
	8 9 10 11 12 13 14	Based on observation, interview and record review, the licensee did not comply with the section cited above evidenced by the facilities floors and carpet smelling like urine and bowel movement which poses a potential health, safety or personal rights risk to persons in care.	8 9 10 11 12 13 14	The company is required to clean the floors and carpets in the main areas, in the main bathrooms, in the main hallways, and in all the resident’s bedrooms and bathrooms. POC is due 8/8/23.
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: Efren Malagon	TELEPHONE: (951) 248-8222
LICENSING EVALUATOR NAME: Ryan Gardner	TELEPHONE: (951) 836-3180
LICENSING EVALUATOR SIGNATURE:	DATE: 07/18/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 11

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 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
11/16/2022 and conducted by Evaluator Ryan Gardner

PUBLIC

COMPLAINT CONTROL NUMBER: 56-AS-20221116170954

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: 96	DATE:	07/18/2023
		UNANNOUNCED	TIME BEGAN:	09:20 AM
MET WITH:	Melanie Niez- Administrator		TIME COMPLETED:	11:00 AM

ALLEGATION(S):

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Resident developed a stage 4 pressure injury that developed maggots while in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Ryan Gardner made an unannounced visit to the facility to conclude and issue findings for the investigation that was initiated on 11/18/2022. LPA stated the purpose of the visit and was granted entry and met with Administrator Melanie Niez.

The investigation consisted of interviews with facility staff, interviews with home health nurses, a review of facility records, a review of hospital records, and a review of home health records.

For allegation, Resident developed a stage 4 pressure injury that developed maggots while in care:

During record review, it was discovered that R1 had a surgical procedure in 2021 that developed into surgical wound. R1’s surgical wound was never medically defined as a pressure injury.

Based on the information found and provided, the allegation listed above is deemed UNFOUNDED.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 248-8222
LICENSING EVALUATOR NAME: Ryan Gardner	TELEPHONE: (951) 836-3180
LICENSING EVALUATOR SIGNATURE:	DATE: 07/18/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 3 of 11

Control Number 56-AS-20221116170954

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: BRASWELL'S CHATEAU VILLA	FACILITY NUMBER: 360902129
	VISIT DATE: 07/18/2023

NARRATIVE

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A finding that the complaint is UNFOUNDED means that the allegation was without a reasonable basis. Therefore, the above allegation is dismissed.

During today’s visit, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations.

An exit interview was conducted, and this report (LIC9099) was discussed and provided to Administrator Melanie Niez, along with a copy of the appeal rights.

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 248-8222
LICENSING EVALUATOR NAME: Ryan Gardner	TELEPHONE: (951) 836-3180
LICENSING EVALUATOR SIGNATURE:	DATE: 07/18/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2023

LIC9099 (FAS) - (06/04)

Page: 4 of 11

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 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
11/16/2022 and conducted by Evaluator Ryan Gardner

PUBLIC

COMPLAINT CONTROL NUMBER: 56-AS-20221116170954

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: 96	DATE:	07/18/2023
		UNANNOUNCED	TIME BEGAN:	09:20 AM
MET WITH:	Melanie Niez- Administrator		TIME COMPLETED:	11:00 AM

ALLEGATION(S):

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Resident's surgical wound developed maggots while in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Ryan Gardner made an unannounced visit to the facility to conclude and issue findings for the investigation that was initiated on 11/18/2022. LPA stated the purpose of the visit and was granted entry and met with Administrator Melanie Niez.

The investigation consisted of interviews with facility staff, interviews with home health nurses, a review of facility records, a review of hospital records, and a review of home health records.

For allegation, Resident's surgical wound developed maggots while in care:

During document review, it was discovered that R1 had a surgical procedure in 2021 that developed into a surgical wound. On 9/26/22, R1 was transported to the hospital with a diagnosis of “maggots in head.” It was noted that R1’s last wound care was on 9/23/22. The hospital found that the surgical wound was saturated with active small larvae.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 248-8222
LICENSING EVALUATOR NAME: Ryan Gardner	TELEPHONE: (951) 836-3180
LICENSING EVALUATOR SIGNATURE:	DATE: 07/18/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 5 of 11

Control Number 56-AS-20221116170954

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: BRASWELL'S CHATEAU VILLA	FACILITY NUMBER: 360902129
	VISIT DATE: 07/18/2023

NARRATIVE

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The larvae were extracted and R1 was transported back to the facility to continue wound care and home health care. On 10/21/22 R1 was transported to the hospital, small maggots were found in R1’s surgical wound. The surgical wound had developing larvae and maggots due to R1 refusing skin treatment after the surgical procedure in 2021. R1 received wound care from a wound company six (6) days a week to monitor R1’s surgical wound as best as possible with the refusal of medical care from R1. R1 was scheduled to have follow up appointments with the hospital and specialists to ensure the surgical wound was taken care of appropriately.

During an interview with the facility administrator, the administrator stated that R1 had a medical procedure in 2021 that developed into a wound. The administrator was notified by staff that R1’s surgical wound had maggots in it during September of 2022 and October of 2022. The administrator was unsure how the maggots developed. The facility does not provide wound treatment for R1. The wound treatment is provided by an outside wound care company and by home health. The facility was responsible for “keeping an eye” on R1’s surgical wound and notifying wound care if they observed additional care was needed. If an observation was made, it was documented in R1’s communication log.

During interviews with the facility staff, the staff stated that R1 had a medical procedure that developed into a wound. R1 had an outside wound care company and home health coming into the facility to provide wound care. The facility staff denied being responsible for the care of the wound. The facility staff was instructed to contact the outside providers if the bandage came off or became soiled. If there was facility staff that was an LVN, they were allowed to change the bandage in between the outside providers facility visits. It was noted that there were times when R1 would “pick at” the wound, “fidget at” the wound, and remove the bandage. There was an instance, on an unknown date, when a staff member observed that the bandage had fallen off and maggots were witnessed. The facility staff informed the administrator, and they were informed to call non-emergency services. Emergency medical services arrived at the facility, and R1 was taken to the hospital for treatment.

During the home health nurse interviews, the nurses denied that the wound was a pressure injury. The home health nurses stated they were providing wound care to R1 five (5) times a week and an outside wound company provided wound care one (1) day a week. The nurses stated that R1’s wound was not healing. It was noted that the bandage had a hard time saying on R1’s face due to the wound being close to R1’s hairline.

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 248-8222
LICENSING EVALUATOR NAME: Ryan Gardner	TELEPHONE: (951) 836-3180
LICENSING EVALUATOR SIGNATURE:	DATE: 07/18/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2023

LIC9099 (FAS) - (06/04)

Page: 6 of 11

Control Number 56-AS-20221116170954

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: BRASWELL'S CHATEAU VILLA	FACILITY NUMBER: 360902129
	VISIT DATE: 07/18/2023

NARRATIVE

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Due to this there was a slight bandage opening. It is possible that the opening is how the maggots developed, but there is no way to know for sure. There were times when R1 removed the bandage, or it fell off. R1 was reminded not to touch the bandage. On 10/21/22, a home health nurse observed maggots in the wound and informed staff to call the non-emergency services.

Based on evidence obtained, the allegation listed above is UNSUBSTANTIATED. A finding that the complaint is UNSUBSTANTIATED means 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.

During today’s visit, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations.

An exit interview was conducted, and this report (LIC9099) was discussed and provided to Administrator Melanie Niez, along with a copy of the appeal rights.

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 248-8222
LICENSING EVALUATOR NAME: Ryan Gardner	TELEPHONE: (951) 836-3180
LICENSING EVALUATOR SIGNATURE:	DATE: 07/18/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2023

LIC9099 (FAS) - (06/04)

Page: 7 of 11

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 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
11/16/2022 and conducted by Evaluator Ryan Gardner

PUBLIC

COMPLAINT CONTROL NUMBER: 56-AS-20221116170954

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: 96	DATE:	07/18/2023
		UNANNOUNCED	TIME BEGAN:	09:20 AM
MET WITH:	Melanie Niez- Administrator		TIME COMPLETED:	11:00 AM

ALLEGATION(S):

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Facility staff did not keep the home clean.
Facility staff do not ensure that resident hygiene needs are met.
Facility staff do not ensure that resident's toileting needs are met.
Facility staff do not respond to resident's call for assistance in a timely manner.
Facility staff do not adequately supervise residents in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Ryan Gardner made an unannounced visit to the facility to conclude and issue findings for the investigation that was initiated on 11/18/2022. LPA stated the purpose of the visit and was granted entry and met with Administrator Melanie Niez.

The investigation consisted of interviews with facility staff, interviews with residents, and a review of facility records.

For allegation, Facility staff did not keep the home clean:

During document review, LPA reviewed the housekeeping staff schedule. The facility has three (3) housekeepers on shift during the week. Over the weekend, the caregivers clean the facility. During interviews with the residents, the residents stated that their bedrooms are cleaned once a week. If a resident requests an additional cleaning, the staff will clean the resident’s room as needed.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 248-8222
LICENSING EVALUATOR NAME: Ryan Gardner	TELEPHONE: (951) 836-3180
LICENSING EVALUATOR SIGNATURE:	DATE: 07/18/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 8 of 11

Control Number 56-AS-20221116170954

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: BRASWELL'S CHATEAU VILLA	FACILITY NUMBER: 360902129
	VISIT DATE: 07/18/2023

NARRATIVE

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During interviews with the staff, the staff stated that the residents’ bedrooms are cleaned weekly. If a resident requests additional cleaning, the staff will clean the resident’s bedroom in between the next scheduled cleaning. The main areas of the facility are cleaned once a week. If a main area needs to be cleaned more than once a week, the staff will clean the area in between the weekly cleaning.

For allegation, Facility staff do not ensure that resident hygiene needs are met:

During interviews with residents, the residents either shower on their own, or have the staff assist with showering. The residents did not have any concerns about their hygiene and showering needs. During interviews with staff, the staff stated that the facility has a caregiver that strictly does the showering for the residents. The caregiver follows a shower schedule, so the residents are showered on a regular basis, unless a resident refuses a shower. During document review, LPA reviewed the shower schedule for the residents. The shower schedule details which residents receive shower assistance and how often they receive assistance. The schedule differs for each resident based on their individual care needs.

For allegation, Facility staff do not ensure that resident's toileting needs are met:

During interviews with residents, the residents stated that their diapers were changed appropriately and there were no issues with the time frame staff provided toileting needs. During interviews with the staff, the staff stated that the residents’ diapers are changed multiple times throughout the day. At minimum, diapers are checked when residents wake up in the morning, before breakfast, after breakfast, before lunch, after lunch, before dinner, and before bed. If a resident needs an additional diaper change, the residents can use their call button and a staff will come to change their diaper. The staff stated that they have not had any complaints from the residents regarding their toileting needs.

For allegation, Facility staff do not respond to resident's call for assistance in a timely manner:

During interviews with residents, the residents stated that there were no issues with the staff responding to their calls for assistance. The average amount of time a resident waited for a staff member to arrive is five (5) to ten (10) minutes. During interviews with staff, the staff stated that they respond to the residents’ calls within five (5) to ten (10) minutes.

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 248-8222
LICENSING EVALUATOR NAME: Ryan Gardner	TELEPHONE: (951) 836-3180
LICENSING EVALUATOR SIGNATURE:	DATE: 07/18/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2023

LIC9099 (FAS) - (06/04)

Page: 10 of 11

Control Number 56-AS-20221116170954

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: BRASWELL'S CHATEAU VILLA	FACILITY NUMBER: 360902129
	VISIT DATE: 07/18/2023

NARRATIVE

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For allegation, Facility staff do not adequately supervise residents in care:

It was alleged that a resident was left unsupervised where they got into trays of partially eaten food.

During document review, LPA reviewed the facilities LIC 500 and their staffing schedule. The facility has staffing to care for the residents throughout the day. During interviews with residents, the residents stated that staff are always present to help them when needed. The residents did not have any concerns about food trays being left out for extended periods. During interviews with the staff, the staff stated the only time food trays were left outside of the resident’s bedrooms was when a resident was in isolation due to medical concerns. The trays of food were placed outside the door when a resident was done with their meal and picked up by the housekeeping staff as soon as the meal was completed. The staff was not aware of any situations where a resident ate food that was left on the floor.

Based on evidence obtained, the allegation listed above is UNSUBSTANTIATED. A finding that the complaint is UNSUBSTANTIATED means 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.

During today’s visit, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations.

An exit interview was conducted, and this report (LIC9099) was discussed and provided to Administrator Melanie Niez, along with a copy of the appeal rights.

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 248-8222
LICENSING EVALUATOR NAME: Ryan Gardner	TELEPHONE: (951) 836-3180
LICENSING EVALUATOR SIGNATURE:	DATE: 07/18/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2023

LIC9099 (FAS) - (06/04)

Page: 9 of 11

Control Number 56-AS-20221116170954

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: BRASWELL'S CHATEAU VILLA	FACILITY NUMBER: 360902129
	VISIT DATE: 07/18/2023

NARRATIVE

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During interviews with staff, the staff stated that the facility smells like urine and bowel movement. The staff has tried to use different types of cleaning agents and cleaning techniques, but the smell is still present after cleaning. The staff stated that they believe the smell is penetrated into the flooring and carpet throughout the facility.

Based on evidence obtained, the allegation listed above is deemed SUBSTANTIATED. A finding that the complaint is SUBSTANTIATED means that the allegation is valid because of the preponderance of evidence the standard has been met.

During today’s visit, one (1) deficiency was cited per Title 22, Division 6, of the California Code of Regulations.

An exit interview was conducted, and this report (LIC9099) and LIC9099D were discussed and provided to Administrator Melanie Niez, along with a copy of the appeal rights.

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 248-8222
LICENSING EVALUATOR NAME: Ryan Gardner	TELEPHONE: (951) 836-3180
LICENSING EVALUATOR SIGNATURE:	DATE: 07/18/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2023

LIC9099 (FAS) - (06/04)

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