191601027-1-24-2024-11-AS-JHAD-D2WUJS-20240229143801

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 191601027
Report Date: 01/24/2024
Date Signed: 01/24/2024 01:32:51 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
01/17/2024 and conducted by Evaluator Lizeth Villegas

COMPLAINT CONTROL NUMBER: 11-AS-20240117105646

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:	01/24/2024
		UNANNOUNCED	TIME BEGAN:	09:01 AM
MET WITH:	Executive Director Ruth Tistoj		TIME COMPLETED:	02:15 PM

ALLEGATION(S):

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Staff mismanaged residents’ medication
Staff falsify documents

INVESTIGATION FINDINGS:

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On 01/24/24 at 9:00 a.m., Licensing Program Analyst (LPA) Lizeth Villegas conducted an initial complaint visit regarding the allegations above. LPA met with Executive Director (ED) Ruth Tistoj as the purpose of today’s visit was explained.

The investigation consisted of the following: On 01/24/24 LPA interviewed Executive Director (ED), staff #1 (S1), and residents # 1-5 (R1-R5). On 01/24/24 LPA conducted a controlled medication review for residents #6-9 (R6-R9), obtained copies of the following: staff and resident rosters, list of all residents on Narcotics and PRn’s, and med tech certificates and LVN license. On 01/24/24 LPA also obtained the following for R6-R8; Admission information, preplacement appraisal, physicians report, physicians orders, Mar for January 2024, controlled drug records, controlled medication count log, service plan, and admission agreements.
The investigation revealed the following:
Allegation: Staff mismanaged residents’ medication

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: 01/24/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2024

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-20240117105646

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: 01/24/2024

NARRATIVE

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It is alleged that staff mismanaged residents’ medication. On 01/24/23 LPA interviewed ED regarding the above allegation, ED denied the allegation above reporting that there are no missing medications only missing signatures. ED continued to report that double signatures are required at each med count which is conducted during every shift. On 01/24/23 LPA interviewed S1 regarding the above allegation, S1 denied the allegation above stating that there have not been any medication errors since previous errors were fixed. S1 reported that medications are counted 3 times, 1 time per shift. On 01/24/24 LPA interviewed R1-R5 regarding the above allegation, 5 of 5 residents interviewed denied the allegation above and reported receiving medications daily with no issues or concerns. On 01/24/24 LPA conducted a review of controlled medications, quick Mar and controlled medications count log for R6-R9 and did not observe any discrepancies.

Allegation: Staff falsify documents

It is alleged that staff falsify documents. On 01/24/23 LPA interviewed ED regarding the above allegation, ED denied the allegation above reporting that two signatures are required during every medication count. ED continued to report that ED checks Quick mar daily to ensure that all required signatures are produced, ED reports that if a signature is missing the staff on shift will be called and asked to return to produced required signature although this is yet to occur. On 01/24/23 LPA interviewed S1 regarding the above allegation, S1 denied the allegation above stating that the staff on shift will be called and will be asked why a signature was not provided. S1 stated that ED will be made aware when a signature is not provided. On 01/24/24 LPA observed quick mar, controlled medication count log, and controlled drug records to have required signatures.

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 Tistoj, 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: 01/24/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2024

LIC9099 (FAS) - (06/04)

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