<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198320417
Report Date: 12/31/2024
Date Signed: 12/31/2024 01:00:42 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
07/25/2024 and conducted by Evaluator Lizeth Villegas
COMPLAINT CONTROL NUMBER: 11-AS-20240725125526
FACILITY NAME:BRITTANY HOUSEFACILITY NUMBER:
198320417
ADMINISTRATOR:WINKELBAUER, SHANEFACILITY TYPE:
740
ADDRESS:5401 E CENTRALIA STTELEPHONE:
(562) 421-4717
CITY:LONG BEACHSTATE: CAZIP CODE:
90808
CAPACITY:170CENSUS: 57DATE:
12/31/2024
UNANNOUNCEDTIME BEGAN:
08:35 AM
MET WITH:Resident care coordinator Marcus FalanaiTIME COMPLETED:
01:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff do not report incidents to residents' responsible parties.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 12/31/24 the department conducted a subsequent complaint visit regarding the allegations above. LPA met with Resident care coordinator Marcus Falanai as the purpose of the visit was explained.

The investigation consisted of the following: On 07/31/2024 at 9:30 am Licensing Program Analyst (LPA), David España conducted an initial complaint visit. On 07/31/2024 as part of the LPA España investigation, LPA requested documents for Resident #1-#6 (R1-R6), Staff #1-#6 (S1-S6), and a staff and resident roster. On 12/04/24 LPA Villegas obtain copies of the staff and resident rosters, and between 9:30am-1pm LPA conducted interviews with residents #3-5 (R3-R5), Staff #1 (S1), and Witness#1 (W1). On 07/31/2024 as part of the LPA España interviewed staff 5-7 (s5-s7) . On 12/19/24 between 9:30am-11:30 am LPA Villegas conducted interviews with S2-S4. On 12/31/24 LPA Villegas conducted a medication review for 4 residents, and a review of trainings for 3 caregivers, and 3 med-techs.

The investigation revealed the following:
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Lizeth Villegas
LICENSING EVALUATOR SIGNATURE:

DATE: 12/31/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/31/2024
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 6
Control Number 11-AS-20240725125526
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: 12/31/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Allegation: Staff do not report incidents to residents' responsible parties.

It is being alleged that the facility consistently fails to report fall incident or notify families of their loved ones' deteriorating conditions. On 12/04/24 between 9:30am-1pm LPA conducted interviews with (R3-R5) regarding the allegation above, 3 of 3 residents interviewed denied the allegation and denied experiencing a fall or injury while in care. On 12/04/24 LPA Villegas was unable to interview R1 as R1 is no longer receiving care at Brittany House. On 12/04/24 LPA conducted over the phone interview with POA for R1, per POA facility did notify POA of fall as R1 was being transported to hospital by ambulance. On 12/04/24 LPA Villegas was unable to interview R2 due to communication barrios. On 12/04/24 LPA interviewed S1 regarding the allegation above, 1 of 1 staff interviewed denied the allegation above and reported S1 will review the written report before faxing it to CCLD and obtaining a fax confirmation number. On 07/31/2024 and 12/19/24 between 9:30am-11:30 am LPA Villegas interviewed S2-S7 regarding the allegation above, 3 of 6 staff interviewed denied the allegation above and reported documenting when responsible parties are notified in the communication folder, 3 of 6 staff interviewed stated being unaware of the reporting procedures are after incidents are reported to the med room staff on shift.

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, and a copy of this report was provided.
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Lizeth Villegas
LICENSING EVALUATOR SIGNATURE:

DATE: 12/31/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/31/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 6
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
07/25/2024 and conducted by Evaluator Lizeth Villegas
COMPLAINT CONTROL NUMBER: 11-AS-20240725125526

FACILITY NAME:BRITTANY HOUSEFACILITY NUMBER:
198320417
ADMINISTRATOR:WINKELBAUER, SHANEFACILITY TYPE:
740
ADDRESS:5401 E CENTRALIA STTELEPHONE:
(562) 421-4717
CITY:LONG BEACHSTATE: CAZIP CODE:
90808
CAPACITY:170CENSUS: 57DATE:
12/31/2024
UNANNOUNCEDTIME BEGAN:
08:35 AM
MET WITH:Resident care coordinator Marcus FalanaiTIME COMPLETED:
01:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff do not administer medications as prescribed.
Staff are not properly trained.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 12/31/24 the department conducted a subsequent complaint visit regarding the allegations above. LPA met with Resident care coordinator Marcus Falanai as the purpose of the visit was explained.

The investigation consisted of the following: On 07/31/2024 at 9:30 am Licensing Program Analyst (LPA), David España conducted an initial complaint visit. On 07/31/2024 as part of the LPA España investigation, LPA requested documents for Resident #1-#6 (R1-R6), Staff #1-#6 (S1-S6), and a staff and resident roster. On 12/04/24 LPA Villegas obtain copies of the staff and resident rosters, and between 9:30am-1pm LPA conducted interviews with residents #3-5 (R3-R5), Staff #1 (S1), and Witness#1 (W1). On 12/19/24 between 9:30am-11:30 am LPA Villegas conducted interviews with S2-S4. On 07/31/2024 as part of the LPA España interviewed staff 5-7 (s5-s7). On 12/31/24 LPA Villegas conducted a medication review for 4 residents, and a review of trainings for 3 caregivers, and 3 med-techs.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Lizeth Villegas
LICENSING EVALUATOR SIGNATURE:

DATE: 12/31/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/31/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 6
Control Number 11-AS-20240725125526
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: 12/31/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Allegation: Staff do not administer medications as prescribed.

It is being alleged medications are frequently administered late or improperly.

On 12/04/24 LPA Villegas interviewed S1 regarding the allegation above, 1 of 1 staff interviewed denied the allegation above and reported documenting if there is a medication error. On 07/31/2024 and 12/19/24 between 9:30am-11:30 am LPAs Espana and LPA Villegas interviewed S2-S7 regarding the allegation above 3 of 6 staff denied the allegation above, 3 of 6 staff interviewed reported they do not assist with medication therefore are unaware of the medication administration process. On 12/04/24 between 9:30am-1pm LPA conducted interviews with (R3-R5) regarding the allegation above, 2 of 3 residents interviewed denied the allegation above, 1 of 3 residents interviewed reported not taking any medications. On 12/04/24 LPA Villegas was unable to interview R1 as R1 is no longer receiving care at Brittany House. On 12/04/24 LPA conducted over the phone interview with POA for R1, per POA facility did not administer antibiotics are prescribed to R1. On 12/04/24 LPA Villegas was unable to interview R2 due to communication barrios. On 12/31/24 at 11:30am LPA Villegas conducted review of MAR for 4 residents, LPA Villegas observed that the MARs weren’t checked off and observed med tech was checking off meds that were passed during the AM during the review. On 12/31/24 1 of 7 overall staff interviewed disclosed medications errors are currently being worked on in order to correct discrepancies previously cites by LPA Brown on 12/10/24 and LPA Iniguez on 12/16/24.

Allegation: Staff are not properly trained.

It is being alleged that the facility has staff members who fail to complete mandatory annual training.

On 12/04/24 LPA Villegas interviewed S1 regarding the allegation above, 1 of 1 staff interviewed denied the allegation above and reported training is ongoing. On 07/31/2024 and 12/19/24 between 9:30am-11:30 am LPA Villegas interviewed S2-S7 regarding the allegation above, 1 of 3 staff denied the allegation above and reported shadowing for 2 weeks, 1 staff reported shadowing for 1 week, 1 staff reporting not having much training, and 3 of 6 staff reported training is upon hire with in-services as needed. On 12/04/24 between 9:30am-1pm LPA Villegas conducted interviews with (R3-R5) regarding the allegation above, 3 of 3 residents interviewed denied the allegation above and reported feeling safe when assisted by staff. On 12/04/24 LPA Villegas was unable to interview R1 as R1 is no longer receiving care at Brittany House. On 12/04/24 LPA conducted over the phone interview with POA for R1, per POA all

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Lizeth Villegas
LICENSING EVALUATOR SIGNATURE:

DATE: 12/31/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/31/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 6
Control Number 11-AS-20240725125526
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: 12/31/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
the “good caregivers” are no longer employed at the facility. On 12/04/24 LPA Villegas was unable to interview R2 due to communication barrios. On 12/31/24 LPA Villegas conducted a review of training records for 3 caregivers and observed completed required trainings in the personnel file. On 12/31/24 LPA requested copies of training for 3 meds techs however, LPA was not provide with training and was informed there is not documented training's for med techs on file.

Based on LPAs observations and interviews which were conducted record review(s), the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be substantiated. California Code of Regulations, Title 22, Division (6) and Chapter (8)are being cited on the attached LIC 9099D.



Exit interview conducted, appeal rights explained, and a copy of this report was provided.
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Lizeth Villegas
LICENSING EVALUATOR SIGNATURE:

DATE: 12/31/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/31/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 6
Control Number 11-AS-20240725125526
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: 12/31/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/14/2025
Section Cited
CCR
87465(h)(6)(A-H)
1
2
3
4
5
6
7
87465 Incidental Medical and Dental Care
The following requirements shall apply to medications which are centrally stored:
The licensee shall be responsible for assuring that a record of centrally stored prescription medications....
The name of the resident for whom....
1
2
3
4
5
6
7
Licesee and Administrator will develope a plan detailing how the facility will ensure all medications are properly administered and documented. Plan to be submitted to LPA by POC due date.
Lizeth.villegas@dss.ca.gov
8
9
10
11
12
13
14
Based on interviews and record reviews, the licensee and Administrator did not comply with the section cited above as medications passes were not properly documeted which is a potential a potentila health and safety risk for residents in care.
8
9
10
11
12
13
14
Type B
01/14/2025
Section Cited
CCR
87412(c)(1-2)
1
2
3
4
5
6
7
87412 personnel records
Licensees shall maintain in the personnel records verification of required staff training and orientation. The following staff training and orientation shall be documented: For staff who assist with personal activities of daily living....
1
2
3
4
5
6
7
Licesee and Administrator will enure all staff have required training by an appropriate skilled professional and provide the department with training sign in sheets, and instructures contact info and crendials by POC due date. LPA provided a copy of section 87412 for refrence.
8
9
10
11
12
13
14
Based on interviews and record reviews, the licensee and Administrator did not comply with the section cited above as there was no documentation confirming Staff 5-7 have obtained and passed required training(s).
8
9
10
11
12
13
14
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: Janae Hammond
LICENSING EVALUATOR NAME: Lizeth Villegas
LICENSING EVALUATOR SIGNATURE:

DATE: 12/31/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/31/2024
LIC9099 (FAS) - (06/04)
Page: 6 of 6