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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 191601027
Report Date: 12/20/2023
Date Signed: 02/09/2024 03:18:48 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 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
11/09/2023 and conducted by Evaluator Jose Calderon
COMPLAINT CONTROL NUMBER: 11-AS-20231109085225
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: 70DATE:
12/20/2023
UNANNOUNCEDTIME BEGAN:
01:39 PM
MET WITH:ADMINISTRATOR RUTH TISTOJTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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9
Licensee does not ensure that the facility has an administrator
INVESTIGATION FINDINGS:
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9
10
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13
THIS REPORT SUPERSEDES THE REPORT DATED 12/20/2023 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 11/17/2023 and was greeted by Consultant Michael Burston (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 allegation.
Investigation consisted of: LPA Calderon interviewed Administrator (A1), Staff (S1-S5), Resident (R1-R7). These interviews were conducted on 11/17/2023. On 11/17/2023 LPA Calderon obtained and reviewed copies of the following: Physician Report (dated 04/04/2023), Preplacement Appraisal (date 5/14/2021). Staff work schedule (date 10/30/2023 to 11/17/2023).
The investigation revealed the following:

Substantiated
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: 12/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2023
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 11-AS-20231109085225
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: BRITTANY HOUSE
FACILITY NUMBER: 191601027
VISIT DATE: 12/20/2023
NARRATIVE
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Regarding Allegation #1: Licensee does not ensure that the facility has an administrator.

This complaint alleged consultant fired the facility administrator with no active administrator working for the facility. LPA Calderon interviewed (A1). (A1) stated that the former administrator was terminated on 10/30/2023, and no acting administrator was working at the facility. (A1) claimed that (A1) was hired by the facility as a consultant and does not handle the facility's day-to-day operations. (A1) explained that (A1) is currently looking to hire an administrator for the facility. However, no administrator has been hired as of 11/17/2023. LPA Calderon interviewed (5) out of (5) staff #1-#5 (S1-S5) stated that the prior administrator was released on 10/30/2023 and the facility had been operating without an administrator. Five out of five


staff reported that (A1) acted in the role of an administrator even though claimed (A1) was only a consultant.

Based on interviews, observations, and supporting documentation, the preponderance of evidence standard has been met; therefore, the allegation of “licensee does not ensure that the facility has an administrator” is found to be SUBSTANTIATED.

According to the California Code of Regulations (Title 22, Division 6, Chapter 8) the following deficiency has been observed and citation issued (ref LIC9099D).

A face-to-face meeting was conducted with Consultant Michael Burston, and a hard copy was provided.

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

DATE: 12/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 11-AS-20231109085225
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

FACILITY NAME: BRITTANY HOUSE
FACILITY NUMBER: 191601027
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/20/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/29/2023
Section Cited
CCR
87355(e)(2)
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3
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7
87355 Criminal Record Clearance
(e) All individuals subject to a criminal record ..(b) shall prior to working, residing, or volunteering in a licensed facility: (2) Request a transfer of a criminal record clearance as specified in Section 87355(c) This requirement was not met as evidence by:
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Licensee will ensure all staff is associated at the facility. In addition, licensee must submit proper documentation to CCL to associate consultants, proof of correction must be sent to LPA via email before POC due date.
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Based on a review of records and interviews, licensee did not associate the two consultants overseeing the administration of the facility. This poses an immediate health and safety risk to all residents in care.
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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: Eva M AlvarezTELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Jose CalderonTELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:

DATE: 12/20/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2023
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
EL SEGUNDO ASC, 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
11/09/2023 and conducted by Evaluator Jose Calderon
COMPLAINT CONTROL NUMBER: 11-AS-20231109085225

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: 70DATE:
12/20/2023
UNANNOUNCEDTIME BEGAN:
01:39 PM
MET WITH:ADMINISTRATOR RUTH TISTOJTIME COMPLETED:
03:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Insufficient Staffing
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
THIS REPORT SUPERSEDES THE REPORT DATED 12/20/2023 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 11/17/2023 and was greeted by Consultant Michael Burston (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-S5), Resident (R1-R7). These interviews were conducted on 11/17/2023. On 11/17/2023 LPA Calderon obtained and reviewed copies of the following: Physician Report (dated 04/04/2023), Preplacement Appraisal (date 5/14/2021). Staff work schedule (date 10/30/2023 to 11/17/2023).
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: 12/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2023
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 11-AS-20231109085225
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: BRITTANY HOUSE
FACILITY NUMBER: 191601027
VISIT DATE: 12/20/2023
NARRATIVE
1
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3
4
5
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7
8
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12
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Regarding Allegation #1: Insufficient staffing.

This complaint alleged that there are not enough staff for facility shifts. LPA Calderon interviewed (A1). (A1) stated that there are 70 staff members working the day and night shifts. (A1) stated that (A1) had a meeting on 11/16/2023 regarding staffing and that unless a staff member calls out sick there is sufficient coverage for three shifts. LPA Calderon interviewed (5) out of (5) staff #1-#5 (S1-S5) claimed that there are no staffing issues unless a staff member calls out sick for their shift. Five out of five staff reported that a designated floater staff is called on duty for coverage when a staff member is out sick, or a staff will work a double shift. Five out of five staff reported that there are enough staff to provide services to call residents.

Residents #1-#7 (R1-R7) were interviewed by LPA Calderon, who provided limited statements. One out of seven residents stated that there are sufficient staff to attend to their needs throughout the day. On 11/17/2023, LPA Calderon reviewed the Daily Staffing Work Schedule (date 10/30/2023 to 11/17/2023), LPA Calderon identified four resident units, AM, PM, and Night shifts, on average there are three staff members in each unit for each shift.



Based on interviews, observations, and supporting documents. The preponderance of evidence standard has NOT been met; therefore, the allegation of “Insufficient Staffing” is found to be UNSUBSTANTIATED.

An exit interview was conducted with Consultant Michael Burston, and a copy of the report was issued.
SUPERVISOR'S NAME: Eva M AlvarezTELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Jose CalderonTELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:

DATE: 12/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2023
LIC9099 (FAS) - (06/04)
Page: 5 of 5