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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 360902129
Report Date: 11/27/2024
Date Signed: 11/27/2024 01:55:54 PM

Document Has Been Signed on 11/27/2024 01:55 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 ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:BRASWELL'S CHATEAU VILLAFACILITY NUMBER:
360902129
ADMINISTRATOR/
DIRECTOR:		JAMES BRASWELLFACILITY TYPE:
740
ADDRESS:620 E. HIGHLAND AVENUETELEPHONE:
(909) 793-0433
CITY:REDLANDSSTATE: CAZIP CODE:
92374
CAPACITY: 156; 156TOTAL ENROLLED CHILDREN: 0CENSUS: 113DATE:
11/27/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:50 AM
MET WITH:Melanie Niez, AdministratorTIME VISIT/
INSPECTION COMPLETED:
02:00 PM
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Licensing Program Analysts (LPAs) Becky Mann and Sarina Ramirez made an unannounced visit to the facility to conduct an annual inspection. LPAs met with Melanie Niez, Administrator and explained the purpose of the visit. During the visit, LPAs observed residents throughout the common areas, walking around the facility, in their designated rooms and/or participating in activities.

Facility: Facility has a capacity of 156 residents and a current census of 113.

Physical Plant: The facility is operating in the capacity and conditions approved by Community Care Licensing Division (CCLD). Linens and hygiene items are sufficient for residents. LPAs tested 9 residents bathrooms and the hot water temperature were measured between 108.5 to 118 degrees Fahrenheit. LPAs observed 10 bedrooms were equipped with lamps and appropriate lighting to ensure residents comfort and safety. Showers and toilets are equipped with grab bars. Fire alarms and smoke detectors are in working order. There is a signal system installed that is in operating order.

The facility consists of: Library, Media/TV Room, Lounge, Laundry Rooms, Kitchen, Dining Area, Front Lobby, Med-Tech Room, Patio, Staff Break Area, Reception, and all other common areas.

Food Service: The facility has a variety of food available for residents. Non perishable and perishable food is sufficient for the number of residents in care. Pesticides and other toxic chemicals are not stored in food areas, and the kitchen is accessible to residents.

Care & Supervision: Facility has sufficient staff in care for the residents. Toxic items are inaccessible to residents in care.
Nedra BrownTELEPHONE: (951) 202-5776
Becky MannTELEPHONE: 951-248-0306
DATE: 11/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/27/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: 11/27/2024
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Record Review: Current staff has Criminal Clearance, CPR and updated training. Resident records are complete with updated physician reports, admission agreement, and needs and services plan.

Medication: LPAs observed medication room and medications are locked and centrally stored. Medication room has a small refrigerator for medication that require refrigeration. LPAs reviewed 7 resident medications and all meds are taken as prescribed by a physician. Medications matched the Medication Administration Record (MAR) on file.

MISCELLANEOUS: Company transportation is available to residents in care. Fire extinguishers were inspected. Ombudsman poster, CCLD Complaint poster, evacuation plan, activities schedule, resident rights, and Facility license are posted in public view.

There were no deficiencies issued per Title 22.

An exit interview was conducted, and a copy of this report, LIC809, and LIC809C were given to Administrator Melanie Niez at the end of the inspection.
SUPERVISOR'S NAME: Nedra BrownTELEPHONE: (951) 202-5776
LICENSING EVALUATOR NAME: Becky MannTELEPHONE: 951-248-0306
LICENSING EVALUATOR SIGNATURE:

DATE: 11/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/27/2024
LIC809 (FAS) - (06/04)
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