360902129-11-6-2023-18-AS-RSTS-CY466K-20231130193201

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 360902129
Report Date: 11/06/2023
Date Signed: 11/06/2023 03:04:28 PM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO ASC, 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
08/28/2020 and conducted by Evaluator Janette Romero

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20200828161015

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: 110	DATE:	11/06/2023
		UNANNOUNCED	TIME BEGAN:	02:40 PM
MET WITH:	Administrator Melanie Niez		TIME COMPLETED:	03:15 PM

ALLEGATION(S):

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Staff did not clean residents room

INVESTIGATION FINDINGS:

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On 11/6/2023, Licensing Program Analyst (LPA), Janette Romero arrived unannounced to the facility to conclude an investigation into the allegation listed above. LPA met with Administrator, Melanie Niez and explained the purpose of the visit. During the course of the investigation, LPA reviewed resident and staff interviews and conducted a facility file review.

On 8/28/2020, Community Care Licensing, received a complaint investigation stating that "Staff did not clean residents room". It was reported that facility staff did not clean Resident 1’s (R1’s) room for over a week and a half in 2020. The four (4) staff interviewed corroborated that R1’s room had not been properly cleaned, due to the facility facing a housekeeping staffing shortage.

Continued on LIC9099-C.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Jazmond D Harris	TELEPHONE: (951) 212-0616
LICENSING EVALUATOR NAME: Janette Romero	TELEPHONE: (951) 548-2222
LICENSING EVALUATOR SIGNATURE:	DATE: 10/23/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2023

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 18-AS-20200828161015

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: BRASWELL'S CHATEAU VILLA	FACILITY NUMBER: 360902129
	VISIT DATE: 11/06/2023

NARRATIVE

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Continued from LIC9099.

The facility reported that resident’s rooms were scheduled for daily cleaning, which included wiping the surfaces and removing the trash. The facility also reported that residents' rooms were scheduled for a deep cleaning weekly; however, one (1) housekeeper was terminated and another housekeeper was scheduled to be off for three consecutive days. As a result, the facility had one (1) housekeeper scheduled and was unable to clean all 70 rooms in one week. The facility reported temporarily reassigning staff to help clean rooms, until staffing was adequate. Due to the staff shortage, it was revealed that staff were unable to clean residents’ rooms. Based on interviews conducted, the preponderance of evidence standard has been met; therefore, the above allegation above is found to be Substantiated.

The facility will be cited per section 87303 of Title 22 regulations. An exit interview was conducted where a copy of this report was reviewed and provided to Administrator Niez along with LIC9099-D and Appeal Rights.

SUPERVISOR'S NAME: Jazmond D Harris	TELEPHONE: (951) 212-0616
LICENSING EVALUATOR NAME: Janette Romero	TELEPHONE: (951) 548-2222
LICENSING EVALUATOR SIGNATURE:	DATE: 11/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2023

LIC9099 (FAS) - (06/04)

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Control Number 18-AS-20200828161015

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO ASC, 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: 11/06/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 11/16/2023 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. This requirement was not met as evidenced by:	1 2 3 4 5 6 7	The facility generated house keeping checklists and added a weekend house keeper to ensure all rooms are cleaned in a timely manner. Administrator showed LPA the checklists and proof of correction.
	8 9 10 11 12 13 14	Based on interviews conducted, the facility reportedly did not clean R1's room due to a staffing shortage. This poses a potential health and safety 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: Jazmond D Harris	TELEPHONE: (951) 212-0616
LICENSING EVALUATOR NAME: Janette Romero	TELEPHONE: (951) 548-2222
LICENSING EVALUATOR SIGNATURE:	DATE: 11/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2023

LIC9099 (FAS) - (06/04)

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