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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 360902129
Report Date: 08/09/2024
Date Signed: 08/09/2024 03:08:47 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
05/06/2024 and conducted by Evaluator Magda Malcore
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20240506155415
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: 120DATE:
08/09/2024
UNANNOUNCEDTIME BEGAN:
02:45 PM
MET WITH:Melanie NiezTIME COMPLETED:
03:10 PM
ALLEGATION(S):
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Staff hit resident
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs) Magda Malcore and Becky Mann conducted an unannounced visit to the facility to conclude the complaint investigation on the above allegation. LPAs met with Administrator, Melanie Niez, who was informed of today’s visit.

Regarding the allegation, staff hit resident, interviews with facility staff, resident #1(R1), and an outside party corroborate the allegation. Staff #1 admitted tapping R1 on the head during a disagreement. R1’s interview reveals they were hit on the head by S1. LPA record review and the Administrators’ interview reveals, S1 received a write-up and suspension for inappropriate conduct towards R1.

Based on interviews and record review, the allegation is Substantiated. A Substantiated finding means that the allegation 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 ClemonsTELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Magda MalcoreTELEPHONE: 951-248-0316
LICENSING EVALUATOR SIGNATURE:

DATE: 08/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2024
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-20240506155415
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: 08/09/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/12/2024
Section Cited
CCR
87468.1
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Personal Rights of Residents in All Facilities.(a)Residents in all residential care facilities for the elderly shall have all of the following personal rights:(3)To be free from punishment, humiliation, intimidation, abuse, or other actions of a punitive nature…this requirement is not met as evidenced by:
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The Administrator terminated S1 on 5/21/24. No futher action is required.
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Based on interviews and record review, S1 admitted tapping R1 on the head during a disagreement, which poses an immediate health, safety, or personal rights risk to persons in care.
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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 ClemonsTELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Magda MalcoreTELEPHONE: 951-248-0316
LICENSING EVALUATOR SIGNATURE:

DATE: 08/09/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2024
LIC9099 (FAS) - (06/04)
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