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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 360900521
Report Date: 02/12/2024
Date Signed: 02/12/2024 02:28:13 PM

Unsubstantiated


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
, CA 92507
This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/06/2024 and conducted by Evaluator Javier Prieto
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20240206134320
FACILITY NAME:BRASWELL'S MEDITERRANEAN GARDENSFACILITY NUMBER:
360900521
ADMINISTRATOR:KEELY MILLERFACILITY TYPE:
740
ADDRESS:12295 4TH STREETTELEPHONE:
(909) 797-1131
CITY:YUCAIPASTATE: CAZIP CODE:
92399
CAPACITY:130CENSUS: 80DATE:
02/12/2024
UNANNOUNCEDTIME BEGAN:
10:55 AM
MET WITH:Keely Miller, AdministratorTIME COMPLETED:
02:30 PM
ALLEGATION(S):
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Licensee does not ensure facility has running hot water within required temperatures
Licensee does not ensure tap water is safe for consumption
Staff does not ensure facility is kept in clean sanitary conditions at all times
Staff does not ensure facility is kept free of insects
Staff does not ensure waste is properly disposed of for residents in care
Staff does not ensure fresh clean linens are provided for residents in care
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Javier Prieto arrived to the facility to conduct a complaint investigation regarding the above allegations. LPA Prieto met with Administrator Miller and explained the elements of the complaint.

Regarding the allegation that Licensee does not ensure facility has running hot water within required temperatures; LPA Prieto tour facility rooms (#33, 40, 36, 22, 23, 24, 39, 42, 1 and 6) and with the aid of staff #1 (S1) and S2, water temperatures were tested and found to be within allowable temperatures per Regulation and averaging 113 degrees Fahrenheit.
***continued on LIC 9099C***
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Javier Prieto
LICENSING EVALUATOR SIGNATURE:

DATE: 02/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/12/2024
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 3
Control Number 56-AS-20240206134320
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507
FACILITY NAME: BRASWELL'S MEDITERRANEAN GARDENS
FACILITY NUMBER: 360900521
VISIT DATE: 02/12/2024
NARRATIVE
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Regarding the allegation that Licensee does not ensure tap water is safe for consumption; report from the Yucaipa Valley Water District states it met all drinking water quality standards based on over 1, 500 water samples collected throughout the calendar year and reported by independent laboratories to the Division of Drinking and USEPA.

Regarding the allegation that Staff does not ensure facility is kept in clean sanitary conditions at all times; LPA Prieto toured the facility, with the assistance of S1 and S2 and found that the common areas, hallways and dining areas are clean and free of obstruction. LPA inspected ten (10) resident rooms and found them to be clean and sanitary.

Regarding the allegation that Staff does not ensure facility is kept free of insects; LPA Prieto toured the facility, with the assistance of S1 and S2 and found that the common areas, hallways and dining areas are clean and free of insects. LPA inspected ten (10) resident rooms and found them to be free of insects. Records obtained by LPA shows the facility has service from an Exterminator company to spray the facility on a monthly basis.
Regarding the allegation that Staff does not ensure waste is properly disposed of for residents in care; LPA inspected ten (10) resident rooms and found that the waste was properly being disposed of. Resident #1 (R1, R2, R3, R4, R5, & R6) were interviewed in their rooms and state that there waste is being disposed of by staff during regular cleaning hours.

Regarding the allegation that Staff does not ensure fresh clean linens are provided for residents in care; LPA inspected ten (10) resident rooms and found that fresh linen was being provided during regular clean hours. Resident #1 (R1, R2, R3, R4, R5, & R6) were interviewed in their rooms and state that their linens were being supplied by staff during regular cleaning hours. Records retrieved by LPA showing linens are sent out to a cleaning company and returned to then facility on a regular basis.

***continued on LIC 9099C***
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Javier Prieto
LICENSING EVALUATOR SIGNATURE:

DATE: 02/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/12/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 56-AS-20240206134320
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507
FACILITY NAME: BRASWELL'S MEDITERRANEAN GARDENS
FACILITY NUMBER: 360900521
VISIT DATE: 02/12/2024
NARRATIVE
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Based on the information obtained there is not enough evidence that Licensee does not ensure facility has running hot water within required temperatures, Licensee does not ensure tap water is safe for consumption, Staff does not ensure facility is kept in clean sanitary conditions at all times, Staff does not ensure facility is kept free of insects ,Staff does not ensure waste is properly disposed of for residents in care and Staff does not ensure fresh clean linens are provided for residents in care. Therefore, the allegations are deemed UNSUBSTANTIATED at this time.

This report was signed by LPA Prieto and Administrator Miller and a copy of the report was left with the facility.

SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Javier Prieto
LICENSING EVALUATOR SIGNATURE:

DATE: 02/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/12/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3