198320417-12-16-2024-11-AS-EMAZ-DCZUEA-20250117143049

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198320417
Report Date: 12/16/2024
Date Signed: 12/16/2024 04:40:04 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
12/09/2024 and conducted by Evaluator Alfonso Iniguez

COMPLAINT CONTROL NUMBER: 11-AS-20241209150447

FACILITY NAME:	BRITTANY HOUSE		FACILITY NUMBER:	198320417
ADMINISTRATOR:	WINKELBAUER, SHANE		FACILITY TYPE:	740
ADDRESS:	5401 E CENTRALIA ST		TELEPHONE:	(562) 421-4717
CITY:	LONG BEACH	STATE: CA	ZIP CODE:	90808
CAPACITY:	170	CENSUS: 56	DATE:	12/16/2024
		UNANNOUNCED	TIME BEGAN:	09:34 AM
MET WITH:	Mandy Taylor-Executive Director		TIME COMPLETED:	04:30 PM

ALLEGATION(S):

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Staff did not dispense resident’s medication as prescribed.

INVESTIGATION FINDINGS:

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On 12/16/2024 LPA Alfonso Iniguez conducted an unannounced complaint visit. LPA Iniguez met with Mandy Taylor/ Executive Director. LPA Iniguez explained the purpose of this visit.

Investigation Consisted of: LPA conducted the following interviews: Administrator Interview(A#1), Staff Interviews (S#1-S#4) and Resident’s interviews (R#1-R#5). LPA obtained and reviewed the following documents: Resident’s roster, Personnel roster, (R#1-R#5) Identification and Emergency Information, (R#1-R#5) Physicians Assessment or LIC 602A, (R#1-R#5) Inventory List or LIC 621, (R#1-R#5) Medication Administration Record (MARs) from October, November, and December 2024…

Evaluation Report continues LIC 9099-C

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Alfonso Iniguez
LICENSING EVALUATOR SIGNATURE:	DATE: 12/16/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2024

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 7

Control Number 11-AS-20241209150447

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: 198320417
	VISIT DATE: 12/16/2024

NARRATIVE

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Evaluation Report continues LIC 9099-C

Allegation: Staff did not dispense resident’s medication as prescribed.

The details of the complaint alleged that facility staff is not dispensing residents’ medications as prescribed by their physician.

During the records review, LPA Iniguez reviewed (R#1-R#5) Medication Administration Records (MARs) from October through November 2024; LPA Iniguez observed discrepancies During the records review, LPA Iniguez examined the Medication Administration Records (MARs) for residents (R#1-R#5) from October to November 2024. LPA Iniguez identified discrepancies in the medication documentation for all five residents.in all (5) residents' medication documentation. In addition, LPA reviewed (R#1-R#5) Physicians assessment or LIC 602A, LPA noted that all (5) residents are not able to administer their own medications.

During this investigation, LPA found sufficient evidence to support the above-mentioned allegation.

Based on the evidence gathered, interviews conducted, and records reviewed, the preponderance of evidence standard has been met; therefore, the above-mentioned allegation is found to be SUBSTANTIATED.

California Code of Regulations (Title 22, Division 6, Chapter 8), the above-mentioned deficiency was observed, and citation issued (ref. LIC 9099D. )

An exit interview was conducted, and a copy of the Complaint Report was given to Mandy Taylor/Executive Director.

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Alfonso Iniguez
LICENSING EVALUATOR SIGNATURE:	DATE: 12/16/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2024

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20241209150447

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: 198320417
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/16/2024

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 12/30/2024 Section Cited CCR 87465(a)(4)	1 2 3 4 5 6 7	87465(a)(4) Incidental Medical and Dental Care A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care, by compliance with the following: When requested by the prescribing physician or the Department, a record of dosages of medications which are centrally stored shall be maintained by the facility. This requirement is not met as evidenced by:	1 2 3 4 5 6 7	Licensee will ensure facility staff use correctly medication administrator records at all time. As plan of correction, licensee will re-train facility staff on the importance on how to document properly on the resident's MARs. proof of training will be sent to LPA before POC due date.
	8 9 10 11 12 13 14	Based on observation and record review, the licensee did not comply with the section cited above as during medication reviews, LPA observed discrepancies in all 5 residents medication administration records which poses/posed a potential health, safety or personal rights risk to persons in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Alfonso Iniguez
LICENSING EVALUATOR SIGNATURE:	DATE: 12/16/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2024

LIC9099 (FAS) - (06/04)

Page: 3 of 7

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
12/09/2024 and conducted by Evaluator Alfonso Iniguez

COMPLAINT CONTROL NUMBER: 11-AS-20241209150447

FACILITY NAME:	BRITTANY HOUSE		FACILITY NUMBER:	198320417
ADMINISTRATOR:	WINKELBAUER, SHANE		FACILITY TYPE:	740
ADDRESS:	5401 E CENTRALIA ST		TELEPHONE:	(562) 421-4717
CITY:	LONG BEACH	STATE: CA	ZIP CODE:	90808
CAPACITY:	170	CENSUS: 56	DATE:	12/16/2024
		UNANNOUNCED	TIME BEGAN:	09:34 AM
MET WITH:	Mandy Taylor-Executive Director		TIME COMPLETED:	04:30 PM

ALLEGATION(S):

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Staff spoke to resident in an inappropriate manner.
Staff did not allow resident to have private phone calls.
Staff did not safeguard resident's personal belongings.
Staff did not provide resident with prescribed medical garment.
Staff did not ensure facility floors were maintained in clean condition.

INVESTIGATION FINDINGS:

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Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Alfonso Iniguez
LICENSING EVALUATOR SIGNATURE:	DATE: 12/16/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2024

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 7

Control Number 11-AS-20241209150447

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: 198320417
	VISIT DATE: 12/16/2024

NARRATIVE

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Investigation Revealed the Following:

Allegation: Staff spoke to resident in an inappropriate manner.

The details of the complaint alleged that facility staff spoke to a resident in care in an inappropriate manner.

During an interview with the administrator (A#1), she and other facility staff never spoke inappropriately to a resident in care. Also, (A#1) stated that facility staff, including her, treat residents with dignity and respect.

During interviews with residents (R#1-R#5), (4) out of (5) stated that they have never spoken inappropriately.

During interviews with staff (S#1-S#4), (4) out (4) stated that they have never inappropriately spoken to residents in care and they treat all residents with dignity and respect.

Allegation: Staff did not allow resident to have private phone calls.

The details of the complaint alleged that facility staff is not allowing residents in care to have private phone calls.

During a health and safety check of the facility, LPA Iniguez observed that the telephone is located in one of the common areas. The place has the ability to close the door for more private conversations.

During an Interview with the Administrator (A#1), she stated that the residents can make and receive private phone calls, and she and the facility staff have never listened to their private conversations.

During interviews with residents (R#1-R#5), (4) out of (5) stated that they can have private phone call conversations.

Evaluation Report continues LIC 9099-C

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Alfonso Iniguez
LICENSING EVALUATOR SIGNATURE:	DATE: 12/16/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2024

LIC9099 (FAS) - (06/04)

Page: 5 of 7

Control Number 11-AS-20241209150447

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: 198320417
	VISIT DATE: 12/16/2024

NARRATIVE

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During interviews with staff (S#1-S#4), (4) out of (4) stated that the residents are able to have private phone conversations, and they have never been listed to them.

Allegation: Staff did not safeguard resident's personal belongings.

The details of the complaint alleged that facility staff is throwing away resident’s personal belongings.

During the records review, LPA Iniguez reviewed (R#1) 's Client/Resident's Personal Property and Valuables or LIC 621; LPA observed that (R#1) refused to have their personal belongings listed. In addition, LPA reviewed (R#1) 's Physicians Assessment or LIC 602A dated 11/3/2024; LPA noted that it is listed that (R#1) has a cognitive impairment. Moreover, LPA observed that (R#2-R#5) had their inventory list on file.

During an Interview with the Administrator (A#1), she stated that the facility is safeguarding residents' belongings and is not throwing them away.

During interviews with residents (R#1-R#5), (4) out of (5) stated that the facility is safeguarding their personal belongings.

During interviews with staff (S#1-S#4), (4) out (4) stated that the facility is safeguarding residents' belongings and is not throwing them away.

Allegation: Staff did not provide resident with prescribed medical garment.

The details of the complaint alleged that facility staff is not providing prescribed medical garment to resident in care.

During the records review, LPA Iniguez reviewed (R#1)’s medical file, and there was no doctor’s order for a medical garment.

Evaluation Report continues LIC 9099-C

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Alfonso Iniguez
LICENSING EVALUATOR SIGNATURE:	DATE: 12/16/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2024

LIC9099 (FAS) - (06/04)

Page: 6 of 7

Control Number 11-AS-20241209150447

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: 198320417
	VISIT DATE: 12/16/2024

NARRATIVE

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During an Interview with the Administrator (A#1), she stated that they provide prescribed medical garments if a medical order (R#1) does not have one on file.

During interviews with residents (R#1-R#5), (4) out of (5) stated that the facility provides the items prescribed by their physician.

Allegation: Staff did not ensure facility floors were maintained in clean condition.

The details of the complaint alleged that facility is not clean and sanitary.

During a health and safety check of the facility, LPA Iniguez observed that it was clean and sanitary.

During an Interview with the Administrator (A#1), she stated that the facility is clean and sanitary.

During interviews with residents (R#1-R#5), (4) out of (5) stated that the facility is clean and sanitary.

During interviews with staff (S#1-S#4), (4) out (4) stated that the facility is clean and sanitary.

During this investigation, LPA found did not find sufficient evident to support the above-mentioned allegations.

Based on the evidence gathered, interviews conducted, and records reviewed, the preponderance of evidence standard has been met; therefore, the above-mentioned allegation(s) are found to be UNSUBSTANTIATED.

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur.

An exit interview was conducted, and a copy of the Complaint Report was given to Mandy Taylor / Executive Director.

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Alfonso Iniguez
LICENSING EVALUATOR SIGNATURE:	DATE: 12/16/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2024

LIC9099 (FAS) - (06/04)

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