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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 191601027
Report Date: 03/30/2022
Date Signed: 03/30/2022 09:42:37 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/18/2022 and conducted by Evaluator Susan Campos
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20220218100005
FACILITY NAME:BRITTANY HOUSEFACILITY NUMBER:
191601027
ADMINISTRATOR:COLLEEN ROZATTIFACILITY TYPE:
740
ADDRESS:5401 E. CENTRALIA STREETTELEPHONE:
(562) 421-4717
CITY:LONG BEACHSTATE: CAZIP CODE:
90808
CAPACITY:170CENSUS: 50DATE:
03/30/2022
UNANNOUNCEDTIME BEGAN:
04:35 PM
MET WITH:Moe TogafauTIME COMPLETED:
05:00 PM
ALLEGATION(S):
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Facility is limiting resident's visitation
INVESTIGATION FINDINGS:
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On 3/30/2022 at 4:35 pm, Licensing Program Analyst (LPA)/ Susan Campos, initiated a subsequent complaint investigation visit for the allegation listed above. LPA was allowed entry into the facility by Resident Care Manager Moe Togafau. LPA explained to Mr. Togafau the purpose of the visit. The investigation consisted of the following: LPA conducted interviews with (6) staff members and (5) residents on 2/23/22, and (1) staff person, per telephone, on 3/3/22. In addition, on 2/23/22, LPA and Tisa Houston conducted an inspection, for health and safety of the facilities’ physical plant, and food supply. LPA also requested the following documents from Assistant Administrator Tisa Houston: LIC 500-Staff roster, Client roster, Staff schedule, House Rules, Admission Agreement, and Facility Visitation policy and procedures.

Continued on LIC 9099C
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Michael CavaTELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: Susan CamposTELEPHONE: (323) 629-7445
LICENSING EVALUATOR SIGNATURE:

DATE: 03/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2022
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 11-AS-20220218100005
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: BRITTANY HOUSE
FACILITY NUMBER: 191601027
VISIT DATE: 03/30/2022
NARRATIVE
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Investigation Revealed

Allegation: Facility is limiting resident's visitation

The investigation revealed, per LPA interviews, with (7) staff members, and (5) residents from the Britany House, that the facility is limiting resident’s visitation. On 2/23/22, S1 informed the LPA, that the facility has a visitation procedure, for resident family and responsible parties, to follow in order to visit facility residents. S1 stated that was informed by S7, that facility resident visitors, first call the facility receptionist, and schedule a 30 minute appointment Monday through Friday, from the hours of 10:30am -11:30am, and 1:30pm-3pm, scheduled appointment time selections are 10:30am, 11:00am, 11:30am, 1:30pm, 2:00pm, 2:30pm, 3:00pm, a total of 7 resident visitor appointment times are available per day, each appointment slot is for 30 minutes, and a resident may have one visitor during the time slot; however S7, may approve to include two additional visitors, during resident’s visitation appointment time. In addition, S1 informed the LPA, that in order to give all residents the opportunity to have a visitor appointment, every resident is given one visitor appointment time per week. S1 informed the LPA, that the resident visitors are escorted to a designated visiting area inside the facility for the 30-minute appointment, located in corridor from the floor hallway, or the other option is the outside patio/ quad area. Visits are not conducted in the resident’s room. The facility receptionist keeps track of the 30-minute visitor appointment time, and when the 30-minute time has lapsed, the receptionist will then contact a caregiver, stationed near the visiting area, to inform the visitor, that the 30-minute visit has been completed, and the caregiver will then escort the visitor to the facility lobby. S1 informed the LPA that resident visitors do not conduct visitations inside the resident’s room. S1 further stated, that there is an exception for residents that are on hospice or are at the end of life stage. In this case resident visitors can have an extended resident visitation in the resident’s room, and will be scheduling their resident visitation visits directly with S7. LPA interviewed 6 staff members, on 2/23/22, and 6 of 6 staff members informed the LPA that S7 oversees the facility visitor policy. In addition, 6 of 6 staff members informed the LPA the resident visits occur Monday-Friday, 10:30am-11:30am, and 1:30pm-3pm, for 30 minutes, and also that the 30-minute time is monitored by the receptionist. The LPA also interviewed 5 residents, and 5 of 5 residents informed the LPA that the staff assist them with their needs, and also 5 of 5 residents interviewed did not provide LPA information regarding complaint allegation. LPA observed that all visitors that enter the facility are screened per COVID intake procedures, at the entry reception station.


Continued on LIC 9099C
SUPERVISOR'S NAME: Ulysses CoronelTELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: Susan CamposTELEPHONE: (323) 629-7445
LICENSING EVALUATOR SIGNATURE:

DATE: 03/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 11-AS-20220218100005
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: BRITTANY HOUSE
FACILITY NUMBER: 191601027
VISIT DATE: 03/30/2022
NARRATIVE
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On 3/3/22, LPA interviewed S7, per telephone, S7 informed the LPA, that resident visitors, may visit a resident for more than 30 minutes, and that there have been exceptions to the 30-minute visitation time limit. In addition, S7 stated that more than one person may visit a resident during the visitation appointment. S7 also stated that there is no scheduled weekend visits; however, exceptions can be made for a resident visit during the weekend if arranged by the weekend supervisor.

On 2/23/22, LPA was informed by S1, that the facility resident visitation is per scheduled 30-minute appointments, Monday-Friday, from the hours of 10:30am -11:30am, and 1:30pm-3pm. And are conducted in a designated visitation area, from the side corridor of the hallway.

Based on LPA observations and interviews which were conducted and record reviews, the preponderance of evidence standard has been met, therefore the above allegations is found to be substantiated. California Code of Regulations, Title 22, Division 6 and Chapter 8 are being cited on the attached LIC 9099D. A hard copy of a LIC 9099 and LIC 9099D was provided to Facility Care Manager Moe Togafau.

SUPERVISOR'S NAME: Michael CavaTELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: Susan CamposTELEPHONE: (323) 629-7445
LICENSING EVALUATOR SIGNATURE:

DATE: 03/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 11-AS-20220218100005
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: BRITTANY HOUSE
FACILITY NUMBER: 191601027
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/30/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/08/2022
Section Cited
CCR
87468.1
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87468.1Personal Rights of Residents in All Facilities...(11)To have their visitors, including ombudspersons and advocacy representatives, permitted to visit privately during reasonable hours and without prior notice, provided that the rights of other residents are not infringed upon.
This requirement is not met as evidenced by:
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Administrator will provide LPA, per fax, a facility visitation plan with reasonable hours, for visitation from Monday-Sunday, a method for visitor to notify facility of visitation, and also provide visitation privacy in resident’s room, if visitor meets COVID testing policy. And also, Administrator will provide LPA with method of notification of facility visitation plan to
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Based on interview, observation, and record review the licensee failed to ensure the residents personal rights. On 2/23/22, LPA was informed by 6 staff members that resident visitation is conducted, by scheduled 30-minute appointments from Monday-Friday, from the hours of 10:30am -11:30am, and 1:30pm-3pm. and that the receptionist, will keep track of the 30-minute visit, and inform staff when to escort visitor out of the facility, and also visitation are not allowed in the resident's room, which posed a potential health risk to residents in care.
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facility staff and resident responsible parties.

LPA fax number (323) 981-1781
POC Due Date is 4/15/22
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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: Michael CavaTELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: Susan CamposTELEPHONE: (323) 629-7445
LICENSING EVALUATOR SIGNATURE:

DATE: 03/30/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2022
LIC9099 (FAS) - (06/04)
Page: 4 of 4