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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 360902129
Report Date: 09/22/2023
Date Signed: 09/22/2023 01:01:05 PM


Document Has Been Signed on 09/22/2023 01:01 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		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 VILLAFACILITY NUMBER:
360902129
ADMINISTRATOR:MELANIE NIEZFACILITY TYPE:
740
ADDRESS:620 E. HIGHLAND AVENUETELEPHONE:
(909) 793-0433
CITY:REDLANDSSTATE: CAZIP CODE:
92374
CAPACITY:156; 156CENSUS: 107DATE:
09/22/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Melanie Niez, AdministratorTIME COMPLETED:
01:05 PM
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Licensing Program Analyst (LPA) Magda Malcore conducted an unannounced plan of correction (POC) visit to the facility. LPA met with Administrator, Melanie Niez, and discussed the purpose of the visit.

A deficiency was cited during complaint visit #56-AS-20230912135704. POC was due on 9/16/23 and as of today’s visit 9/22/23 POC has not been corrected, as resident 1 (R1) has not been admitted back to the facility.

A civil penalty was accessed today for failure to correct the deficiency and civil penalties will continue to accrue $100 per day until proof of correction has been received.



An exit interview was conducted and a copy of this report with appeal rights was provided to Administrator, Niez at the conclusion of the visit.
SUPERVISOR'S NAME: Karen ClemonsTELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Magda MalcoreTELEPHONE: 951-248-0316
LICENSING EVALUATOR SIGNATURE:
DATE: 09/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/22/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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