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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 360900100
Report Date: 05/08/2025
Date Signed: 05/08/2025 12:44:44 PM

Substantiated


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
08/02/2021 and conducted by Evaluator Becky Mann
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20210802150441
FACILITY NAME:BRASWELLS YUCAIPA LEISURE MANORFACILITY NUMBER:
360900100
ADMINISTRATOR:LINDA WOOFTERFACILITY TYPE:
740
ADDRESS:32195 AVENUE ETELEPHONE:
(909) 797-1314
CITY:YUCAIPASTATE: CAZIP CODE:
92399
CAPACITY:61CENSUS: 51DATE:
05/08/2025
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Administrator Linda WoofterTIME COMPLETED:
12:55 PM
ALLEGATION(S):
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Residents are not assisted with their toileting needs
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPA) Becky Mann and Antoinette Davis conducted an unannounced visit to the facility to initiate a complaint investigation. LPA Mann and Davis met with Linda Woofter, Administrator and explained the purpose of today's visit. The investigation consisted of LPAs observations, pertinent document reviews, and interviews with staff and residents.

The allegation that residents are not assisted with their toileting needs. Based on LPAs observations, Resident #1 (R1) was found in their room while laying on their bed, was found soaked in adult pull-ups. The right side of R1 pants were soaked in urine. LPAs could smell the urine in the room while interviewing R1.

Based on LPAs observations, the above allegation is Substantiated. A determination that the complaint is substantiated means that the allegation is/are valid because the preponderance of the evidence standard has been met. An exit interview was conducted where this report was discussed and provided to Linda Woofter, Administrator and appeal rights.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Becky Mann
LICENSING EVALUATOR SIGNATURE:

DATE: 05/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 4
Control Number 18-AS-20210802150441
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: BRASWELLS YUCAIPA LEISURE MANOR
FACILITY NUMBER: 360900100
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/08/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/15/2025
Section Cited
HSC
87625(b)(3)
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87625 Managed Incontinence (b) In addition to Section 87611, the licensee shall be responsible for the following:
(3) Ensuring that incontinent residents are kept clean and dry and that the facility remains free of odors from incontinence. This requirement is not met as evidenced by:
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Administrator told staff to change resident adult pull ups while LPAs was at the facility. LPAs recommended facility maintain a incontinence log for residents and email log to LPA by Plan of Correction (POC) due date
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Based on LPAs observations staff did not change resident's pull ups in a timely manner. LPAs observed resident soaked in adult pull up which poses a health and safety risk to residents 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.
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Becky Mann
LICENSING EVALUATOR SIGNATURE:

DATE: 05/08/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 4
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
08/02/2021 and conducted by Evaluator Becky Mann
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20210802150441

FACILITY NAME:BRASWELLS YUCAIPA LEISURE MANORFACILITY NUMBER:
360900100
ADMINISTRATOR:LINDA WOOFTERFACILITY TYPE:
740
ADDRESS:32195 AVENUE ETELEPHONE:
(909) 797-1314
CITY:YUCAIPASTATE: CAZIP CODE:
92399
CAPACITY:61CENSUS: 51DATE:
05/08/2025
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Administrator Linda WoofterTIME COMPLETED:
12:55 PM
ALLEGATION(S):
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Resident food is not prepared in a safe and healthful manner
Kitchen staff do not practice personal hygiene
Residents are not assisted with showers appropriately
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPA) Becky Mann and Antoinette Davis conducted an unannounced visit to the facility to initiate a complaint investigation. LPA Mann met with Linda Woofter, Administrator and explained the purpose of today's visit. The investigation consisted of LPAs observations, pertinent document reviews, and interviews with staff and residents.

The allegation that resident food is not prepared in a safe and healthful manner. Five (5) staff interviewed stated that resident's food is prepared in a safe and healthful manner. Six (6) residents interviewed stated that the food is prepared in a safe and healthful manner. LPAs toured the kitchen area, observed that staff were wearing gloves as well as changing gloves in between job duties.

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Becky Mann
LICENSING EVALUATOR SIGNATURE:

DATE: 05/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 18-AS-20210802150441
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: BRASWELLS YUCAIPA LEISURE MANOR
FACILITY NUMBER: 360900100
VISIT DATE: 05/08/2025
NARRATIVE
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The allegation that kitchen staff do not practice personal hygiene. Five (5) staff interviewed stated that kitchen staff does practice personal hygiene. Six (6) residents interviewed stated that kitchen staff does practice personal hygiene. Based on LPAs observations, kitchen staff does follow proper hygiene and safety guidelines while handling food.

The allegation that residents are not assisted with showers appropriately. Three (3) staff interviewed stated that residents are assisted with showers appropriately. Three (3) residents interviewed stated that they are assisted with showers appropriately. LPAs observed a monthly shower log that staff use to maintain shower frequency. Based on LPAs observations, interviews and record reviews, the shower log is accurate and properly maintained.

Based on evidence obtained during this investigation, the allegations above are Unsubstantiated; meaning that 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.

An exit interview was conducted where this report was discussed and a copy of this report was provided to Linda Woofter, Administrator at the conclusion of the visit.

SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Becky Mann
LICENSING EVALUATOR SIGNATURE:

DATE: 05/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 4