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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 191601027
Report Date: 01/08/2024
Date Signed: 02/08/2024 12:48:57 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/04/2024 and conducted by Evaluator Jose Calderon
COMPLAINT CONTROL NUMBER: 11-AS-20240104152351
FACILITY NAME:BRITTANY HOUSEFACILITY NUMBER:
191601027
ADMINISTRATOR:COLLEN ROZATIFACILITY TYPE:
740
ADDRESS:5401 E. CENTRALIA STREETTELEPHONE:
(562) 421-4717
CITY:LONG BEACHSTATE: CAZIP CODE:
90808
CAPACITY:170CENSUS: 65DATE:
01/08/2024
UNANNOUNCEDTIME BEGAN:
09:07 AM
MET WITH:ADMINISTRATOR RUTH TISTOJTIME COMPLETED:
03:30 PM
ALLEGATION(S):
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9
Staff did not adequately address a change in resident’s condition.
Staff did not inform resident’s authorized representative of change in resident's condition.
Staff did not provide emergency medical personnel with resident’s medical information.
INVESTIGATION FINDINGS:
1
2
3
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THIS REPORT SUPERSEDES THE REPORT DATED 01/08/2024 FOR CLARIFYING THE CIRCUMSTANCE FOR THE ALLEGATIONS. ALTHOUGH THIS REPORT SUPERSEDES THE PREVIOUS REPORT THE COMPLAINT INVESTIGATION FINDINGS REMAIN THE SAME: UNSUBSTANTIATED
Licensing Program Analyst (LPA) Jose Calderon conducted an unannounced visit to Brittany House Facility on 01/08/2024 and was greeted by Administrator Ruth Tistoj (A1). LPA Calderon spoke to A1 prior to entering the facility to conduct a risk assessment. LPA Calderon explained the purpose of this visit is to deliver the findings pertaining to the above-mentioned allegations.
During this investigation, LPA Calderon interviewed Administrator (A1), Staff (S1-S2), Client (C1-C6), Witness (W1-W6). These interviews were conducted on 01/08/2024. On 01/08/2024 LPA Calderon obtained and reviewed Incident report (date 01/01/2024), Needs and Service Plan (date 10/08/2023), Physician Report (date 11/06/2023), Admission agreement (date 10/09/2020). Internal incident report (date 01/01/2024)
The investigation revealed the following:


Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Eva M AlvarezTELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Jose CalderonTELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:

DATE: 01/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/08/2024
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 11-AS-20240104152351
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME: BRITTANY HOUSE
FACILITY NUMBER: 191601027
VISIT DATE: 01/08/2024
NARRATIVE
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Regarding Allegation #1: Staff did not adequately address a change in client’s condition.This complaint alleged staff did not notice the change in the clients’ condition. LPA Calderon conducted an interview with Administrator Ruth Tistoj (A1). A1 states that the facility does have 6 levels of care and C1 is in level 3 care. A1 states that if C1 needed more care than staff could provide in unit 3, C1 would be moved to a higher level of care or be moved out of the facility. LPA Calderon conducted an interview with S1-S2. 2 out of 2 staff state that C1 is in unit 3 and the level of care is for clients with dementia but can still move. 2 out of 2 staff state that if C1 medical condition changes they update the clients’ records and inform A1 so that changes can be made to the level of care provided. LPA Calderon conducted an interview with C2-C6. C1 passed away on 01/01/2024 and could not be interviewed. C2-C6 have health conditions and could not be interviewed. LPA Calderon conducted an interview with witnesses W2-W6 family members. 5 out of 6 witnesses stated that their family members “love” living at the facility and 5 out of 6 witnesses stated that they do not have any issues with care provided by staff. Reviewed the physician report (date 11/06/2023), C1 has health condition and was in unit 3 care. C1 was in a wheelchair and needed staff help with all services.Regarding Allegation #2: Staff did not inform clients authorized representative of change in clients’ condition.

This complaint alleged staff did not inform clients conservator of C1 change in condition. LPA Calderon conducted an interview with Administrator Ruth Tistoj (A1). A1 states that A1 staff are trained to call clients’ family members with any change in medical conditions. A1 states that on 01/01/2024 staff noticed C1 oxygen level was low and 911 was called. The nurse called the W1 and the W1’s husband cell phone with no response. The nurse left messages for C1 family to call. LPA Calderon conducted an interview with S1-S2. S1 states that S1 noticed a change in C1 medical condition and called 911. S1 states that S1 called W1 cell and W1 husband cell 3 times with no answer. S1 states that S1 left messages for C1 family members to call and C1 was transported to the hospital for evaluation. S2 states that all staff are trained to call 911 and then call the clients’ family. S2 states that S1 did call C1 family and there was no answer. S2 states that S1 left a message for C1 family to call. C1 passed away on 01/01/2024 and could not be interviewed. C2-C6 have health conditions and could not be interviewed. LPA Calderon conducted an interview with witnesses W2-W6 family members. 5 out of 6 witnesses state that staff does call and updates W2-W6 on any changes to their family members. Reviewed internal incident report (date 01/01/2024). S1 filled out report and notes C1 having health conditions. S1 called 911 and then called C1 W1 family members 3 times. S1 left a message for C1 family members to call. The report states that W1 family members had returned the call around 5pm.

SUPERVISOR'S NAME: Eva M AlvarezTELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Jose CalderonTELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:

DATE: 01/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/08/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3
Control Number 11-AS-20240104152351
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME: BRITTANY HOUSE
FACILITY NUMBER: 191601027
VISIT DATE: 01/08/2024
NARRATIVE
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Regarding Allegation #3: Staff did not provide emergency medical personnel with client’s medical information.

This complaint alleged staff did not provide emergency medical personnel with C1 medical information. LPA Calderon conducted an interview with Administrator Ruth Tistoj (A1). A1 states that S1 reported C1 was taken to the hospital for health issues on 01/01/2024. A1 states that there was no DNR on record. A1 states that if there was a DNR on record 911 would not have been called and staff would have provided a copy of the DNR to emergency services. LPA Calderon conducted an interview with S1-S2. S1 states that when S1 went to C1 room and checked on C1 the medical condition, S1 reviewed C1 chart notes and no DNR was found. S1 states that if there was a DNR on record S1 would not have called 911. S1 states that S1 would have given a copy of the DNR to emergency services if there was such a document. S2 states that S2 could not find any DNR document on file and does not believe C1 had an DNR record on file. LPA Calderon conducted an interview with C2-C6. C1 passed away on 01/01/2024 and could not be interviewed. C2-C6 have health conditions and could not be interviewed. LPA Calderon conducted an interview with witnesses W2-W6 family members. 5 out of 6 witnesses state that their family member has a DNR on record and facility staff has a record of the DNR on file. LPA Calderon reviewed C1 facility file and could not find a DNR on file.

Based on interviews, observations, and supporting documentation, the preponderance of evidence standard has been met; therefore, the allegations of “staff did not adequately address a change in clients’ condition” “staff did not inform clients authorized representative of change in clients’ condition”, “staff did not provide emergency medical personnel with clients medical information” is found to be UNSUBSTANTIATED.



An exit interview was conducted, and a copy of the Complaint Report was provided to the Administrator Ruth Tistoj (A1).
SUPERVISOR'S NAME: Eva M AlvarezTELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Jose CalderonTELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:

DATE: 01/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/08/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3