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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 360900521
Report Date: 09/08/2025
Date Signed: 09/08/2025 03:43:00 PM

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
09/04/2025 and conducted by Evaluator Edith Conchas
COMPLAINT CONTROL NUMBER: 56-AS-20250904150342
FACILITY NAME:BRASWELL'S MEDITERRANEAN GARDENSFACILITY NUMBER:
360900521
ADMINISTRATOR:LYNETTE HUMPHREYFACILITY TYPE:
740
ADDRESS:12295 4TH STREETTELEPHONE:
(909) 797-1131
CITY:YUCAIPASTATE: CAZIP CODE:
92399
CAPACITY:130CENSUS: 77DATE:
09/08/2025
UNANNOUNCEDTIME BEGAN:
01:36 PM
MET WITH:Dorrie Loo Director of Operations and Clinical services TIME COMPLETED:
03:55 PM
ALLEGATION(S):
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Staff inappropriately told the paramedics resident had dementia
Staff did not allow resident to view her records
INVESTIGATION FINDINGS:
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On September 8th, 2025 Licensing Program Analyst’s (LPAs) Edith Conchas and Renese Howell-Small made an unannounced visit to the facility to conduct a complaint investigation regarding the above allegations. LPAs explained the purpose of the visit to the Director of Operations and Clinical Services, Dorie Loo. The investigation consisted of file review, interviews with staff and resident(s).

#1 Staff inappropriately told the paramedics resident had dementia– Based on interview, 3 out of 3 staff stated Braswell’s Family Senior Care does not accept residents with Dementia unless a resident receives Hospice care. Staff 1 stated that they did not give any report to paramedics that Resident 1 (R1) had a Dementia diagnosis. An interview with R1 confirmed that R1 does not have dementia. Based on interview, this allegation is UNSUBSTANTIATED.

*** Continuation in LIC9099C ***
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Edith Conchas
LICENSING EVALUATOR SIGNATURE:

DATE: 09/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2025
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 2
Control Number 56-AS-20250904150342
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 MEDITERRANEAN GARDENS
FACILITY NUMBER: 360900521
VISIT DATE: 09/08/2025
NARRATIVE
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#2 Staff did not allow resident to view their records- Based on interviews, 3 out of 3 staff stated that all residents have access to their files and can request them at any time. An Interview with Resident 1 (R1) stated that when they requested access to see “where in the file resident has dementia” staff were unable to provide the information because this information was not documented. When LPAs reviewed R1’s file, the Physician’s Report did not state that R1 has dementia. Based on interview and record review, this allegation is UNSUBSTANTIATED.

During the investigation, LPA did not find evidence to corroborate the allegations.

Based on the evidence, the allegations mentioned above are UNSUBSTANTIATED. A finding that the complaint is UNSUBSTANTIATED means 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 where this report, LIC9099, LIC909C, were discussed and copies provided to Director of Operations and Clinical Services Dorie Loo.

SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Edith Conchas
LICENSING EVALUATOR SIGNATURE:

DATE: 09/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2