360902129-9-14-2023-56-AS-KCLS-CWHV7S-20231011161137

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 360902129
Report Date: 09/14/2023
Date Signed: 09/14/2023 02:48:43 PM

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
09/12/2023 and conducted by Evaluator Magda Malcore

PUBLIC

COMPLAINT CONTROL NUMBER: 56-AS-20230912135704

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; 156	CENSUS: 111	DATE:	09/14/2023
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Melanie Niez, Administrator		TIME COMPLETED:	02:50 PM

ALLEGATION(S):

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Staff violated resident's personal rights

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Magda Malcore conducted an unannounced complaint visit to the facility. LPA met with Melanie Niez, Administrator and discussed the purpose of the visit.
Regarding the allegation, staff violated resident's personal rights, Administrator Niez stated that Resident #1 (R1) was exhibiting aggressive behaviors toward theirself and others as a result law enforcement was contacted and R1 was placed on a 51/50 hold on 9/3/2023. Administrator Niez was informed by hospital staff that R1 was ready to be discharged to the facility. Administrator informed hospital staff that R1 is not permitted to return to the facility due to R1 being a danger to theirself and others.
Based on pertinent record review and interviews with relevant parties, the allegation is Substantiated.
A finding that the complaint is Substantiated means that the allegation(s) is valid because the preponderance of the evidence standard has been met.
An exit interview was conducted where reports (LIC9099&LIC9099-D) were discussed and provided with appeal rights to the administrator at the conclusion of the visit.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Karen Clemons	TELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Magda Malcore	TELEPHONE: 951-248-0316
LICENSING EVALUATOR SIGNATURE:	DATE: 09/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2023

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-20230912135704

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: 09/14/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 09/16/2023 Section Cited CCR 87468.2(a)(20)	1 2 3 4 5 6 7	87468.2Additional Personal Rights of Residents...(a)…residents…for the elderly shall have…personal rights:(20)To be protected from involuntary transfers, discharges, and evictions. A licensee shall not involuntarily transfer or evict residents for reasons other than those permitted by state law or regulations and shall comply with all eviction and relocation protections for residents. This requirement is not met as evidenced by:	1 2 3 4 5 6 7	Licensee/Administrator shall permit R1 to return to the facility and Licensee/Administrator shall submit to the licensing agency a statement of understanding of the cited regulation and proper eviction procedures by POC date.
	8 9 10 11 12 13 14	Administrator did not permit R1 to return to the facility after hospitalization due to R1 being a danger to theirself and others..Licensee/Administrator did not comply with the section cited above by not ensuring R1 with all resident eviction and relocation protections during an involuntary discharge, which poses an immediate health and safety or personal rights risk to persons in care	8 9 10 11 12 13 14
	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: Karen Clemons	TELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Magda Malcore	TELEPHONE: 951-248-0316
LICENSING EVALUATOR SIGNATURE:	DATE: 09/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2023

LIC9099 (FAS) - (06/04)

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