360902129-11-29-2023-18-AS-JDHS-CYAV8P-20231207151303

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 360902129
Report Date: 11/29/2023
Date Signed: 11/29/2023 10:31:58 AM

Unsubstantiated

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
09/18/2020 and conducted by Evaluator Kathleen Banrasavong

COMPLAINT CONTROL NUMBER: 18-AS-20200918151847

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; 156	CENSUS: 107	DATE:	11/29/2023
		UNANNOUNCED	TIME BEGAN:	09:12 AM
MET WITH:	Administrator, Melanie Niez		TIME COMPLETED:	10:45 AM

ALLEGATION(S):

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Resident is not accorded dignity in relationships with staff.
Staff did not assist resident with medications as needed.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA), Kathleen Banrasavong made an unannounced visit to the facility to commence a complaint investigation regarding the allegations listed above. LPA met with Administrator, Melanie Niez, and explained the purpose of the visit and the elements of the allegations. LPA Banrasavong conducted the investigation which consisted of observation, interviews, and record review. LPA attempted on numerous occasions to contact the Reporting Party (RP) The contact number provided was not valid. LPA attempted to do a search through multiple channels and found no contact information within Community Care Licensing’s database. LPA was unable to obtain any additional information at this time.

On 09/18/2020, Community Care Licensing received a complaint stating that staff did not assist resident with medications as needed and Resident is not accorded dignity in relationships with staff. In regards to the allegation of Staff did not assist resident with medications as needed. The allegation was made that the med tech was late in giving Resident 1(R1) medication late or did not give the resident medication at all. The LPA interviewed previous residents and the med tech that lived and worked at the facility during the 2020 year, which revealed there was no issues with medication getting to the resident from the Med Tech.

(Continued on 9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Jazmond D Harris	TELEPHONE: (951) 212-0616
LICENSING EVALUATOR NAME: Kathleen Banrasavong	TELEPHONE: (951) 248-2222
LICENSING EVALUATOR SIGNATURE:	DATE: 11/29/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/29/2023

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-20200918151847

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: 11/29/2023

NARRATIVE

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(Continuation from 9099)
The second allegation in regards to Resident is not accorded dignity in relationships with staff. The allegation was made in regards to the staff member closing the doors to the smoke section. R1 alleged that there is a certain time from 7AM- 8PM, where the doors are supposed to be kept open. R1 stated that the staff would close the door. Information obtained from the interview conducted with Administrator stated that Resident is not accorded dignity in relationships with staff. According to the Administrator the R1 moved out of the facility in January 2022 and the Administrator stated that she did not have any forwarding contact information. The information that the LPA obtained during the investigation, showed that residents that have resided during the 2020 year and current new residents state that there are no issues in regards to the residents getting locked out of the smoking section during the hours of 6AM-9PM.

Based on LPAs observations and record review(s), the preponderance of evidence standard has not been met, therefore the above allegation(s) of Staff did not assist resident with medications as needed, Resident is not accorded dignity in relationships with staff, are found to be unsubstantiated. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur. An exit interview was conducted, a copy of this report, appeal rights was provided to the Administrator, Melanie Niez, as evidenced by her signature.

SUPERVISOR'S NAME: Jazmond D Harris	TELEPHONE: (951) 212-0616
LICENSING EVALUATOR NAME: Kathleen Banrasavong	TELEPHONE: (951) 248-2222
LICENSING EVALUATOR SIGNATURE:	DATE: 11/29/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/29/2023

LIC9099 (FAS) - (06/04)

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