191601027-1-16-2024-11-AS-JHAD-D2FU54-20240214141609

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 191601027
Report Date: 01/12/2024
Date Signed: 01/16/2024 08:55:30 AM

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
12/19/2023 and conducted by Evaluator Lizeth Villegas

COMPLAINT CONTROL NUMBER: 11-AS-20231219105529

FACILITY NAME:	BRITTANY HOUSE		FACILITY NUMBER:	191601027
ADMINISTRATOR:	COLLEN ROZATI		FACILITY TYPE:	740
ADDRESS:	5401 E. CENTRALIA STREET		TELEPHONE:	(562) 421-4717
CITY:	LONG BEACH	STATE: CA	ZIP CODE:	90808
CAPACITY:	170	CENSUS: 68	DATE:	01/12/2024
		UNANNOUNCED	TIME BEGAN:	09:09 AM
MET WITH:	Executive Director Ruth Titsoj		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Staff did not order refills for residents’ medications in a timely manner

INVESTIGATION FINDINGS:

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On 01/12/24 at 9:00 am, Licensing Program Analyst (LPA) Lizeth Villegas conducted a subsequent complaint visit to deliver complaint investigation findings regarding the allegation above. LPA met with Executive Director (ED) Ruth Tistoi as the purpose of today’s visit was explained.

The investigation consisted of the following: On 12/21/23 LPA interviewed Executive Director (ED), Staff #1-2 (S1-S2), and obtained copies of the following: Staff and resident roster and the following documents for R#1, facesheet, identification and emergency information form, admission agreement, pre-placement appraisal, service plan, physicians report, physicians orders, non-delivery notice of medication, centrally stored medication and destruction report, controlled drug record (PRN) form and controlled drug record for R#1-20. On 01/12/24 LPA interviewed Residents #1-10 (R1-10).

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (424) 544-1027
LICENSING EVALUATOR NAME: Lizeth Villegas	TELEPHONE: (818) 391-9974
LICENSING EVALUATOR SIGNATURE:	DATE: 01/12/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/12/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20231219105529

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: 01/12/2024

NARRATIVE

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The investigation revealed the following:
Allegation- Staff did not order refills for residents’ medications in a timely manner.

It is being alleged staff did not order refills for residents’ medications in a timely manner. On 12/21/23 LPA interviewed Executive Director (ED) regarding the above allegation, ED denied the above allegation stating there has not been a medication destruction upon her arrival as Executive Director and per knowledge there was no destruction done prior to Executive Director’s arrival nor has the LVN mentioned it. ED continued to report that medication destruction will only be completed by ED and LVN to ensure no errors are made. On 12/21/23 LPA Villegas interviewed S1-S2 about the above allegation, 2 of 2 staff interviewed denied the above allegation stating there has not been a medication destruction completed. 1 of 2 staff interviewed reported routine cycle medications are automatically delivered to the facility. On 12/21/23 LPA conducted a medication review, medication review revealed residents to have enough medication available at the facility. On 01/12/24 LPA interviewed R1-10 regarding the above allegation, 8 of 10 residents interviewed denied the above allegation. 8 of 10 residents interviewed reported not going without receiving medication and receiving medication in a timely manner. 1 of 10 interviewed did not want to answer LPA’s questions. LPA was unable to interview R1 as R1 is nonverbal.

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, therefore the allegation is Unsubstantiated.

Exit interview conducted with Executive Director Ruth Tistoi, and a copy of this report was provided.

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (424) 544-1027
LICENSING EVALUATOR NAME: Lizeth Villegas	TELEPHONE: (818) 391-9974
LICENSING EVALUATOR SIGNATURE:	DATE: 01/12/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/12/2024

LIC9099 (FAS) - (06/04)

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