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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 360900100
Report Date: 10/06/2026
Date Signed: 10/06/2026 12:03:53 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
12/09/2025 and conducted by Evaluator Beena Singh
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20251209114116
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: 58DATE:
10/06/2026
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Linda Woofter,Facility AdministratorTIME COMPLETED:
01:30 PM
ALLEGATION(S):
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Due to lack of supervision, resident sustained a fracture while in care.
Staff did not report incidents involving a resident in care to the resident's responsible party.
INVESTIGATION FINDINGS:
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First Allegation: Neglect/Lack of Care and Supervision: R1 did not receive timely medical care while under the supervision of the facility/Due to lack of supervision, resident sustained a fracture while in care.

On 12/09/2025, the Department received a complaint alleging Neglect/Lack of Care and Supervision, specifically, R1 did not receive timely medical care while under the supervision of the facility. The Department investigation consisted of review of facility records, medical records, and interviews with staff and pertinent individuals.
Review of medical records revealed R1 sustained a fall resulting in a head injury and a fractured humerus. Interviews with staff revealed that staff did not obtain medical attention in a timely manner. Interviews with staff 1 (S1) and Staff2(S2) revealed facility staff failed to call 911 or arrange for hospital transportation. Interviews with S1 and S2 revealed staff employed at the time treated the injury by applying ice and administering Tylenol with no further documented medical follow-up. S1 and S2 demonstrated a lack of awareness regarding the fall, stating they could not recall, R1 falling or sustaining a head injury.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Beena Singh
LICENSING EVALUATOR SIGNATURE:

DATE: 08/30/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2026
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 5
Control Number 56-AS-20251209114116
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: 10/06/2026
NARRATIVE
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The Department was unable to interview other staff present at the time of the fall; they were no longer employed by facility.

Second Allegation: Staff did not report incidents involving a resident in care to the resident's responsible party. According to interviews and record reviews, facility has no records that facility Staff has informed resident's responsible party about resident#1's falls on 05/18/2020, 10/31/2020, 04/13/2022 incidents.

Based on interviews and record review, R1 did not receive timely medical care while under the supervision of the facility and Staff did not report incidents involving a resident in care to the resident's responsible party are Substantiated. A substantiated finding means that the allegation is valid because the preponderance of the evidence standard has been met.

California Code of Regulations (Title 22, Division & Chapter number) are being cited on the attached LIC 9099D). An Immediate civil penalty for a violation has been assessed in the amount of $500.00.

An exit interview was conducted where reports (LIC9099, LIC 9099-C & LIC9099-D) LIC 421BG (6/17) and Appeal Rights were discussed and provided to Linda Woofter, Facility Administrator, Facility representative at the conclusion of the visit.
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Beena Singh
LICENSING EVALUATOR SIGNATURE:

DATE: 10/06/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 56-AS-20251209114116
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: 10/06/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/07/2026
Section Cited
CCR
82075(a)
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Continuing Requirements 82075 (a)
Health-Related Services (a)The licensee shall ensure that each client receives necessary first aid and other needed medical or dental services, including arrangement for and/or provision of transportation to the nearest available emergency services. This requirement is not met as evidence by:
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Licensee to train all staff on CCR 82075 (a) and submit proof of Training Log(outside agency/ professional/vendored company) and submit signed statement of Understanding on CCR 82075 (a), to LPA Singh by POC due date.
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Based on observation, interviews and record review, the licensee did not comply with the section cited above by not ensuring that the facility staff call for emergency medical services to ensure appropriate medical assessment for the client in care which poses an immediate health, safety or personal rights risk to people in care,
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Type A
10/07/2026
Section Cited
CCR
87468(a)(8)
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PERSONAL RIGHTS:
Each resident shall have the right to have family members or responsible persons regularly informed of activities related to his/her care or services. Responsible party was not informed of incidents that resulted in the resident's falls at the facility,This requirement is not met as evidence by:
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Licensee agreed to conduct and In-Service training pertaining to Personal Rights. Upon completion of training, Licensee is to submit proof along with names/signatures of staff in attendance by POC due date to LPA Singh.
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Based on observation, interviews and record review, the licensee did not comply with the section cited above by not ensuring that the facility staff informed resident's responsible party about resident's falls on 5/18/2020, 10/31/2020 and 4/13/2022 incidents.
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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.
SUPERVISOR'S NAME: Efren Malagon
LICENSING EVALUATOR NAME: Beena Singh
LICENSING EVALUATOR SIGNATURE:

DATE: 10/06/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 5
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
12/09/2025 and conducted by Evaluator Beena Singh
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20251209114116

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: 58DATE:
10/06/2026
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Linda Woofter,Facility AdministratorTIME COMPLETED:
01:30 PM
ALLEGATION(S):
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2
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9
Staff did not seek adequate medical attention for resident injuries while in care.
Staff did not submit a written incident report to the licensing agency regarding a resident in care.
INVESTIGATION FINDINGS:
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First Allegation: - Neglect/Lack of Care and Supervision: R1 sustained an unwitnessed fall due to lack of supervision/Staff did not seek adequate medical attention for resident injuries while in care.
On 12/09/2025, the Department received a complaint alleging R1 sustained an unwitnessed fall due to lack of supervision.
Department Staff investigated the above allegation, R1 sustained an unwitnessed fall due to lack of supervision. The Department investigation consisted of review of facility and hospital medical records, interviews with staff and pertinent individuals.
Medical records obtained from hospital provided a timeline and clinical context surrounding the incident. Record review revealed that R1, was an ambulatory resident who routinely utilized a walker for mobility support. On the day of the incident, R1 returned from an off-site family outing with family and was spending time in the facility’s courtyard. While in the courtyard, walking, utilizing their assistive walker, R1 experienced a fall. There was no evidence that supported R1 sustained an unwitnessed fall due to lack of supervision by staff. R1 was transported and treated at the hospital.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Beena Singh
LICENSING EVALUATOR SIGNATURE:

DATE: 10/06/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 56-AS-20251209114116
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: 10/06/2026
NARRATIVE
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Second Allegation:-Staff did not submit a written incident report to the licensing agency regarding a resident in care.
According to Staff interviews and records reviews,On May 18, 2020, the facility submitted an incident report to the Community Care Licensing Division (CCLD) regarding the presence of bed bugs and pest control in Resident Room 1 (R#1) with incident dated May 17, 2020.
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Based on corroborating evidence LPA has determined that the above allegations 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 reports (LIC9099, LIC 9099-C were discussed and provided to Linda Woofter, Facility Administrator, Facility representative at the conclusion of the visit.
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Beena Singh
LICENSING EVALUATOR SIGNATURE:

DATE: 10/06/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2026
LIC9099 (FAS) - (06/04)
Page: 5 of 5