191601027-1-6-2024-11-AS-MVAO-CZEVJP-20240112152904

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 191601027
Report Date: 01/06/2024
Date Signed: 01/06/2024 01:14:09 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
12/19/2023 and conducted by Evaluator Ernand Dabuet

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20231219124413

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: 65	DATE:	01/06/2024
		UNANNOUNCED	TIME BEGAN:	09:01 AM
MET WITH:	Cansandra Simmons		TIME COMPLETED:	11:59 AM

ALLEGATION(S):

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Staff are not keeping accurate records for narcotic medications.

INVESTIGATION FINDINGS:

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On 01/06/24, Licensing Program Analyst (LPA) Ernand Dabuet conducted an unannounced subsequent complaint visit to this facility. Upon arrival at the facility, LPA Dabuet was greeted by Activity Assistant Cansandra Simmons. LPA explained the purpose of the visit was deliver the findings for the allegation mentioned above.

The investigation consisted of the following: Interviews conducted with staff 1-3 (S1-S3). Inquiry questions were relevant to the nature of the complaint. A record review of documents including: staff and residents’ roster, a list of resident on narcotic medications, a Narcotic Count Sign Sheet, a Controlled Drug Record Form, an Antibiotic Use Form, a Controlled Medication Count, and a Liquid Count Sheet. A tour of the facility was conducted on 12/21/23.

(Evaluation Report continues LIC 9099-C)

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (424) 544-1027
LICENSING EVALUATOR NAME: Ernand Dabuet	TELEPHONE: (323) 629-5526
LICENSING EVALUATOR SIGNATURE:	DATE: 01/06/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/06/2024

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 4

Control Number 11-AS-20231219124413

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: 01/06/2024

NARRATIVE

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INVESTIGATION REVEALED THE FOLLOWING:

Allegation: Staff are not keeping accurate records for narcotic medications.
The details of this complaint alleged that staff are not keeping accurate records of narcotic medications for residents in care. The complainant notified the Community Care licensing by filing this complaint and reported that this facility is not documenting the narcotic medications being given to residents in care. The complainant had brought the issue to the attention of the administrator but failed to do anything about the matter. The complainant did not have the names of the residents or rooms numbers that are being served narcotic medications, however, described unit 2 has the most residents that are receiving narcotic medications.

On 12/21/23 at 10:31 am – 1:00 pm, the Department conducted interviews with (3) out of (3) staff #1-#3 all acknowledged there are medication errors and record keeping errors with the narcotic medications. (S1) admitted that the licensee had hired a consultant to oversee the administration duties from 10/31/23 through 12/11/23. (S1) observed errors in record keeping and documentation of medications. According to (S1), the med room staff failed to use the proper forms after using the registry. On the registry, signatures were missing. Dosage and time registrations were missing. For some residents, the quantity of narcotic medication was incorrect. (S1) stated was uncertain if was implemented accordingly by the former administrator or the hired consultant. Effective 12/12/23, (S1) made changes to rectify the mismanagement of records. (S1) reported an in-service schedule with the pharmacy to come in and train all med techs and nurses on how to properly administer and document medication. (S2-S3) confirmed errors in the documentation of narcotic medications. The staff was utilizing the incorrect registry form of "Controlled Drug Record" when it should have been "Antibiotic Use Form". There should have been an individual Antibiotic Use Form in the morning and one in the evening for each resident. (S2) reported the most common narcotics used by the residents are Lorazepam, Tramadol, and Morphine these are not recorded or kept properly.

On 12/21/23 and 01/06/24, the Department inspected the facility and requested resident and staff rosters. The Department was provided with a list of residents receiving narcotic medications, a Narcotic Count Sign Sheet, a Controlled Drug Record Form, an Antibiotic Use Form, a Controlled Medication Count, and a Liquid Count Sheet.

(Evaluation Report continues LIC 9099-C)

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (424) 544-1027
LICENSING EVALUATOR NAME: Ernand Dabuet	TELEPHONE: (323) 629-5526
LICENSING EVALUATOR SIGNATURE:	DATE: 01/06/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/06/2024

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20231219124413

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: 01/06/2024

NARRATIVE

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The record reviewed revealed there are (21) residents receiving narcotic medications. Only (3) out of (21) were using the correct registry form. There were (4) out of (21) errors in documentation which included missing time, dose count, or signatures.

According to the information gathered and the acknowledgment declaration from staff, there is sufficient evidence to support the allegation mentioned above.

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 were 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 Hammond	TELEPHONE: (424) 544-1027
LICENSING EVALUATOR NAME: Ernand Dabuet	TELEPHONE: (323) 629-5526
LICENSING EVALUATOR SIGNATURE:	DATE: 01/06/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/06/2024

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 11-AS-20231219124413

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: 01/06/2024

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 01/07/2024 Section Cited CCR 87465(d)(3)	1 2 3 4 5 6 7	Incidental Medical and Dental Care (d) If the resident is unable to determine his/her own need for a prescription or nonprescription PRN medication, and is unable to communicate his/her symptoms clearly, facility staff designated by the licensee, shall be permitted to assist the resident with self-administration…(2) The date and time of each contact with the physician, and the physician's directions, shall be documented and maintained… (3) The date and time the PRN medication was taken, the dosage taken… shall be documented and maintained in the resident's facility record.	1 2 3 4 5 6 7	Licensee will submit plan informing the department what steps will take effect in order to prevent documentation and medication errors from occurring. Proof of correction must be submitted by due date: 01/0724 to LPA's email: ernand.dabuet@dabuet@dss.ca.gov
	8 9 10 11 12 13 14	This requirement was not met as evidenced by: Based on interviews and records reviews, the licensee failed to make accurate records for narcotic medications from 10/31/23 – 12/11/23 (see LIC9099-C) for full details. This violation poses a potential health, safety, or personal rights risk to persons in care.	8 9 10 11 12 13 14	Proof of correction was provided during visit 01/06/24.
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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 Hammond	TELEPHONE: (424) 544-1027
LICENSING EVALUATOR NAME: Ernand Dabuet	TELEPHONE: (323) 629-5526
LICENSING EVALUATOR SIGNATURE:	DATE: 01/06/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/06/2024

LIC9099 (FAS) - (06/04)

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