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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 360902129
Report Date: 09/21/2021
Date Signed: 10/21/2021 04:33:27 PM



STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
08/13/2021 and conducted by Evaluator Elecia Weathersby
COMPLAINT CONTROL NUMBER: 18-AS-20210813123312
FACILITY NAME:BRASWELL'S CHATEAU VILLAFACILITY NUMBER:
360902129
ADMINISTRATOR:JAMES BRASWELLFACILITY TYPE:
740
ADDRESS:620 E. HIGHLAND AVENUETELEPHONE:
(909) 793-0433
CITY:REDLANDSSTATE: CAZIP CODE:
92374
CAPACITY:156CENSUS: 86DATE:
09/21/2021
UNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Licensee, Jim BraswellTIME COMPLETED:
03:36 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff are not following residents Dr. order for a special diet
Staff spoke inappropriately to resident
Staff did not keep resident's information confidential
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst's (LPA) Elecia Weathersby made an unannounced visit to the facility for the purpose of investigating complaints regarding the above allegations. LPA met with facility Licensee, Jim Braswell and explained the purpose of the visit. Below is a summary of the findings of the investigation:

Allegation #1: Staff are not following residents Dr. order for a special diet.
LPA Elecia Weathersby interviewed staff and resident R1, who advised this LPA that R1 declines all meals provided by the facility because R1 does not like the facility food. Staff also verified to this LPA that R1 declines all meals prepared.

Allegation #2: Staff spoke inappropriately to resident
LPA Elecia Weathersby conducted a walk-through of the inside and outside of the facility, specifically to interview residents and staff. LPA was unable to verify by sight, record review or interviews, that staff has spoken to any resident inappropriately. LPA witnessed no signs of verbal abuse, health and safety violations or evidence to confirm the allegation, or dismiss it.

Allegation #3 Staff did not keep resident's information confidential
LPA toured the facility, specifically to check facility files for accessibility, reviewed records, and interviewed staff and residents. LPA was unable to confirm that the allegation is true and unable to dismiss the allegation.

Based on LPA Weathersby's observations, records review, and interviews, the allegations are UNSUBSTANTIATED. A finding of Unsubstantiated means although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur.

A copy of this report and appeals right were reviewed with and provided to Licensee, Jim Braswell at the end of the visit.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Efren MalagonTELEPHONE: (951) 248-0337
LICENSING EVALUATOR NAME: Elecia WeathersbyTELEPHONE: (951) 255-9516
LICENSING EVALUATOR SIGNATURE:

DATE: 09/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2021
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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