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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198320417
Report Date: 07/09/2024
Date Signed: 08/19/2024 12:30:38 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
06/11/2024 and conducted by Evaluator Felisa Shirley
COMPLAINT CONTROL NUMBER: 11-AS-20240611084549
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: 70DATE:
07/09/2024
UNANNOUNCEDTIME BEGAN:
12:09 PM
MET WITH:Yessica Martinez, Office ManagerTIME COMPLETED:
10:00 PM
ALLEGATION(S):
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Staff did not safeguard resident's personal belongings.
INVESTIGATION FINDINGS:
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*This report serves as an amendment to clarify findings. It does not supersede the complaint investigation findings reflected on report created 7/10/24.

On 07/10/24 Licensing Program Analyst (LPA) Felisa Shirley conducted an unannounced subsequent complaint visit to the address listed above. LPA was greeted by Office Manager, Yessica Martinez. LPA was granted access to the facility.

The investigation consisted of the following: On 6/13/24, LPA toured the facility to observe and identify any signs of neglect, abuse, or other immediate health and safety threats. LPA requested copies of the following records: Staff Roster, Resident Roster, Staff and Resident interviews, reviewed resident files, and a copy of a delivery receipt from Ideal Home Care, dated 4/25/24.


The investigation revealed the following:

Con'd on 9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Felisa Shirley
LICENSING EVALUATOR SIGNATURE:

DATE: 07/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2024
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-20240611084549
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: 07/09/2024
NARRATIVE
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Allegation: Staff did not safeguard resident’s personal belongings

This facility recently moved residents from one unit to another unit and management received notice that a resident was transferred without their personal belongings. LPA Shirley reviewed the copy of delivery receipt that was provided for missing items and learned that a medical bed, Inner Spring mattress, half bedrails, hoyer lift and wheelchair were delivered to the Brittany House facility on 4/25/24 and was accepted by staff at 7:38pm. On 6/13/24, LPA Shirley went to the resident’s room and took pictures of the equipment that was there. A standard bed, walker, a wheelchair with a pedal leaning against the wall and the other pedal missing, and no hoyer lift. LPA Shirley checked residents closet to verify that the correct clothing were in the residents closet. LPA Shirley checked the laundry room to confirm labeling for residents clothing and was told that the clothes are labeled by families or representatives before the resident moves in. Labeling prevents residents clothing and personal belongings from being separated from the resident or in other residents rooms. LPA spoke with S-1 on 6/17/24. LPA discussed the delivery and acceptance by staff. S-1 stated that they would look into the matter and get back to me. On 6/17/24, S-1 forwarded a video of all of the missing equipment that was now in R-1’s room. LPA was told that missing items were in the storage room #211 and were not being used by another resident. LPA Shirley interviewed staff S1-S5, (S-1 – S-5.) LPA ask, Does the staff here safeguard the resident’s personal belongings? Of those interviewed, 5 out of 5 answered, yes. LPA interviewed residents R-1 – R-7, (R-1 – R-7.) LPA ask, does staff here safeguard your personal belongings. Of those interviewed, 6 out of 7 answered, yes, there was 1 resident whose response did not answer LPA’s question. Based on interviews, the preponderance of evidence has been met therefore the allegation is Substantiated.

Deficiencies were issued for this allegation.



An exit interview was conducted and plans of correction developed with the Administrator Susie Fuentes. A copy of this report and appeals rights was reviewed and left with the Office Manager, Jessica Martinez.
SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Felisa Shirley
LICENSING EVALUATOR SIGNATURE:

DATE: 07/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3
Control Number 11-AS-20240611084549
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: 07/09/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/24/2024
Section Cited
CCR
87217(b)
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87217 Safeguards for Resident Cash, Personal Property, and Valuables
(b) Every facility shall take appropriate measures to safeguard residents' cash resources, personal property and valuables which have been entrusted to the licensee or facility staff. The licensee shall give the residents receipts for all such articles or cash resources.

This requirement is not as evidenced by:
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The Office Manager shall submit in writing a better plan and training for all staff to safeguard residents personal belongings and provide receipts for all such articles to CCLD via fax or email by POC due date of 7/24/24. Proof of correction can be emailed to felisa.shirley@dss.ca.gov.
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Based on document review and interviews, facility staff did not take appropriate measures to safeguard residents belongings. This poses a potential 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.
SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Felisa Shirley
LICENSING EVALUATOR SIGNATURE:

DATE: 07/09/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2024
LIC9099 (FAS) - (06/04)
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