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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 191601027
Report Date: 01/04/2024
Date Signed: 01/04/2024 09:07:43 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, 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
12/27/2023 and conducted by Evaluator Ernand Dabuet
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20231227140131
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:
01/04/2024
UNANNOUNCEDTIME BEGAN:
07:58 AM
MET WITH:Ruth Tistoi - Executive DirectorTIME COMPLETED:
05:00 PM
ALLEGATION(S):
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Staff is not a certified administrator and did not meet qualifications.
INVESTIGATION FINDINGS:
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On 01/04/24, Licensing Program Analyst (LPA) Ernand Dabuet conducted an unannounced complaint visit to this facility. Upon arrival at the facility, LPA Dabuet was greeted by office manager Tisha Houston who contacted Executive Director Ruth Tistoi who later joined for the visit. The purpose of the visit was provided to Tistoj to investigate the allegation mentioned above.

The investigation consisted of the following: Interview conducted with the Executive Director. Inquiry questions were relevant to the nature of the complaint. Interviews with staff #2-#5 (S2-S5). During today’s visit, LPA Dabuet requested and obtained copies of the following documents staff and residents’ roster, and other documents pertinent to this complaint. A tour of the facility was conducted.

Evaluation Report continues LIC 9099-C
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Janae HammondTELEPHONE: (424) 544-1027
LICENSING EVALUATOR NAME: Ernand DabuetTELEPHONE: (323) 629-5526
LICENSING EVALUATOR SIGNATURE:

DATE: 01/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/04/2024
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-20231227140131
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: 01/04/2024
NARRATIVE
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INVESTIGATION REVEALED THE FOLLOWING:

Allegation: Staff is not a certified administrator and did not meet qualifications.
The details of the complaint alleged the facility did not have a certified administrator and did not meet the qualifications. The complainant reported the facility did not have an administrator beginning October 1, 2023 through December 12, 2023 with administrator's qualifications according to Title 22 regulations.

On 01/04/24, the Department interviewed at 10:50 am to 12:59 pm (5) out (5) staff #1-#5 who verified that the facility did not have an executive director/administrator on board during the period of 10/31/23 - 12/11/23. The facility hired a consultant to oversee the operations of the the facility who had the responsibility and authority to carry out the policies of the licensee. Five out of five staff confirmed that the consultant did not claim to be the new administrator, but rather was introduced as the newly hired consultant. Five out of five staff reported that the consultant was responsible for staff hiring, scheduling, and revising senior living community operation guidelines. According to the investigation, the licensee did not utilize the facility's designated backup administrator staff # 2 (S2) but instead utilized a consultant to carry out administrator duties.

The Department reached out to the consultant who was unavailable for an interview. The Department requested personnel records for the consultant from the corporate office, but they were not provided. As the Department searched through the California Department of Social Service (CDSS) Active Certificate and Pending Application List for administrators, there was no information about the consultant. Furthermore, during the period of 10/31/23 to 12/11/23, the licensee failed to inform or report personnel changes to the Department. There is sufficient evidence that the facility used a consultant to carry out the role of an administrator without having the qualifications of a certified administrator between 10/31/23 and 12/11/23.

Based on interviews, observation, and record reviews the licensee violated the California Code Regulations (CCR) of Title 22, Division 6, Chapter 8,

Deficiencies are issued and an exit interview is conducted with Ruth Tistoi. A copy of this report and appeal rights was provided.
Note: *Citations not cleared by the due date will be a $100 fine assessed for each citation until it is cleared. Civil penalties will continue to accrue until Proof of Corrections (POC) is cleared. *
SUPERVISOR'S NAME: Janae HammondTELEPHONE: (424) 544-1027
LICENSING EVALUATOR NAME: Ernand DabuetTELEPHONE: (323) 629-5526
LICENSING EVALUATOR SIGNATURE:

DATE: 01/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/04/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 11-AS-20231227140131
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/04/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/11/2024
Section Cited
CCR
87405(a)
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87405 Administrator - Qualifications and Duties (a) All facilities shall have a qualified and currently certified administrator...The administrator shall have sufficient freedom from other responsibilities.. to permit adequate attention to the management and administration of the facility... When the administrator is not in the facility, there shall be coverage by a designated substitute who shall have qualifications adequate to be responsible and accountable for management and administration of the facility as specified in this section. The Department may require that the administrator devote additional hours in the facility to fulfill his/her responsibilities when the need for such additional hours is substantiated by written documentation.
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Licensee agreed to submit an administrator packet of a certified and qualified designate as the primary administrator in place. Licensee will email an updated LIC 500 by the POC due date 01/11/24.
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This requirement was not met as evidenced by:
Based on interviews and record reviews, the licensee failed to ensure that a qualified and currently certified administrator during the period of 10/31/23 - 12/11/23. This violation poses a potential health, safety, or personal rights risk to persons in care.
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This violation was corrected during the visit. A packet from a newly appointed certified and qualified admnistrator was sent to CCLD 12/15/23.
Type B
01/11/2024
Section Cited
CCR
87211(a)(2)
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87211 Reporting Requirements (a) Each licensee shall furnish to the licensing agency such reports as the Department may require... (2) Occurrences... which threaten the welfare, safety or health of residents, personnel or visitors... reported... by telephone or facsimile to the licensing agency and to the local health officer when appropriate. This poses a potential health, safety, or personal rights risk to persons in care.
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Licensee agreed to review Title 22 87211 and submit a written statement that they have reviewed and understood the regulation and will comply by the POC due date of 01/11/24
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This requirement was not met as evidenced by:
Based on interviews and record reviews, the licensee failed notify or report personnel changes to CCLD that no administrator during the period of 10/31/23 - 12/11/23. This violation poses a potential health, safety, or personal rights risk to persons 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: Janae HammondTELEPHONE: (424) 544-1027
LICENSING EVALUATOR NAME: Ernand DabuetTELEPHONE: (323) 629-5526
LICENSING EVALUATOR SIGNATURE:

DATE: 01/04/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

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