360902129-3-21-2024-56-AS-KCLS-D6LUTB-20240626155136

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 360902129
Report Date: 03/08/2024
Date Signed: 03/21/2024 11:07:42 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
03/04/2024 and conducted by Evaluator Magda Malcore

PUBLIC

COMPLAINT CONTROL NUMBER: 56-AS-20240304085608

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: 110	DATE:	03/08/2024
		UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Melanie Niez - Administrator		TIME COMPLETED:	12:40 PM

ALLEGATION(S):

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Staff does not ensure facility is free of pests and rodents.

INVESTIGATION FINDINGS:

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****This report has been Amended for electronic signatures****
Licensing Program Analyst (LPA) Magda Malcore conducted an unannounced complaint visit to the facility. LPA met with Administrator, Melanie Niez and discussed the purpose of the visit. The investigation consisted of observations, reviewing pertinent documents, and interviews with relevant parties.

Regarding the allegation, Staff does not ensure facility is free of pests and rodents, it is alleged that the facility has a roach and mice infestation and the facility is not making efforts to treat the problem. LPA toured the kitchen and (5) resident bedrooms. Regarding the roach infestation, LPA did not observe a roach infestation and there is not enough evidence to corroborate this allegation. In regards to the rodents, LPA observed in bedroom 11A, two (2) rodent traps. LPA observed one of the traps had a dead rodent, in the trap closest to the sliding glass door. LPA observed in bedroom 33, several rodent traps which included traps in the resident's closet, bathroom, and corners of the bedroom.

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: 03/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/08/2024

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-20240304085608

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: 03/08/2024

NARRATIVE

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****This report has been Amended for electronic signatures****
LPA review of exterminator services performed from December 2023 through today reveal, that on 1/9/24 bait traps were set in the kitchen, on 2/14/24 rodent traps were set in bedroom 11A and 33, on 2/29/24 bedroom 33 was rebaited, and today
(3/8/24) rodent traps were set in bedrooms 11A and 33. In addition, on 2/29/24, the exterminating company made a documented recommendation to have the facility seal the bottom of the hallway backdoor and seal the bottom of bedroom 33's door. LPA asked the Administrator if these recommendations have been addressed, the Administrator stated the facility has hired an outside contractor that will be fixing the doors.
Based on observation and interviews, the allegation is Substantiated. A finding that the complaint is SUBSTANTIATED means that the allegation is valid because the preponderance of the evidence standard has been met.

An exit interview was conducted where the Licensing reports were discussed with Administrator Niez. Copies of the Licensing reports were provided with Appeal Rights to Administrator Niez at the conclusion of the visit.

SUPERVISOR'S NAME: Karen Clemons	TELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Magda Malcore	TELEPHONE: 951-248-0316
LICENSING EVALUATOR SIGNATURE:	DATE: 03/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/08/2024

LIC9099 (FAS) - (06/04)

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Control Number 56-AS-20240304085608

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: 03/08/2024

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 03/09/2024 Section Cited CCR 87303(a)	1 2 3 4 5 6 7	*this is an Amended Report* 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. This requirement is not met as evidenced by:	1 2 3 4 5 6 7	Licensee/Administrator shall submit to the Licensing Agency a self-certification within 24 hours that an exterminator inspection has been scheduled to have the facility inspected for possible structural holes and recommendations for aggressive treatments to help prevent rodent infestations.
	8 9 10 11 12 13 14	The Licensee did not comply with section cited by not aggressively addressing the pest and rodent issue; which poses an immediate health, safety, and personal rights risks to persons in care.	8 9 10 11 12 13 14	Licensee/Administrator shall also submit to the Licensing Agency receipts that an extermination service and inspection has been conducted by 3/15/24.
	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: 03/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/08/2024

LIC9099 (FAS) - (06/04)

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