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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198320417
Report Date: 10/20/2025
Date Signed: 10/20/2025 03:50:23 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
09/09/2025 and conducted by Evaluator Zina Brown
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20250909103914
FACILITY NAME:BRITTANY HOUSEFACILITY NUMBER:
198320417
ADMINISTRATOR:JOEL NIBLETTFACILITY TYPE:
740
ADDRESS:5401 E CENTRALIA STTELEPHONE:
(562) 421-4717
CITY:LONG BEACHSTATE: CAZIP CODE:
90808
CAPACITY:170CENSUS: 122DATE:
10/20/2025
UNANNOUNCEDTIME BEGAN:
08:25 AM
MET WITH:Joel Niblett, AdministratorTIME COMPLETED:
04:00 PM
ALLEGATION(S):
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Staff did not seek timely medical attention.
Licensee did not ensure resident records were maintained and readily available for emergency medical staff.
INVESTIGATION FINDINGS:
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On 10/20/2025 at 8:25am, Licensing Program Analysts (LPAs) Zina Brown conducted a subsequent complaint visit at this facility to deliver findings. During today’s visit, LPAs met with Joel Niblett (Executive Director) & explained the purpose of the visit.

The investigation consisted of the following: On 09/10/2025, an unannounced initial complaint visit was conducted at the facility by Licensing Program Analysts (LPA) Zina Brown. On 09/10/25 LPA Brown interviewed the Residents (R1-R12), between the hours of 10:17am - 11:52, Administrator (A1) between the hours of 3:20pm - 3:38pm and Staff (S1) between the hours of 2:07pm - 2:15pm. LPA requested the resident and staff roster, resident roster, LIC 601; Emergency Info (for R1-R2,R13), LIC 602: Physician's Report for Resident Care Facilities for the Elderly (for R1-R2,R13), Admission Agreement (for R1-R2,R13), LIC 603: Pre-Placement Appraisal (for R1-R2, R13) and Medication Administrator Record (for R1-R2,R13), and Staff Schedule (dated 09/05/2025).

Report continues on LIC 9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Zina Brown
LICENSING EVALUATOR SIGNATURE:

DATE: 10/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2025
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-20250909103914
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: 10/20/2025
NARRATIVE
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The investigation revealed the following:
Allegation: Staff did not seek timely medical attention
It is being alleged that facility staff failed to contact emergency services for a resident in care.

On 09/19/2025, LPA interviewed Administrator (A1) regarding the allegation. A1 denied the allegation. A1 stated that documentation reflected staff recognized the change in the resident’s condition and called 911 for medical attention. A1's expectation of the staff is to respond appropriately and take immediate action when a resident exhibits serious symptoms. A1 indicated that staff are expected to notify a Certified MedTech and/or a Licensed Nurse immediately, and 911 should be called as needed.

On 09/10/2025 and 10/13/2025, LPA conducted interviews with Staff (S1- S4) regarding the allegation above. 1 out of 4 staff interviewed confirmed the allegation above and reported witnessing the incident in question with Resident 13 (R13), per 1 of 4 staff protocol was followed and 911 was called. 1 out of 4 staff interviewed reported being aware of the incident but did not witness it. 2 out of 4 staff interviewed denied the allegation and stated not having knowledge nor witness any emergency regarding the Resident 13 (R13).

On 09/10/2025, between the hours of 10:17am - 11:42am LPA Brown conducted interviews with Residents 1-12 (R1-R12), regarding the allegation above. 1 of 12 residents confirmed the allegation and stated that on the day of 09/10/2025 and a week from 09/10/2025 their neighboring resident had to wait a long time before getting help from the facility staff. 11 of the 12 residents reported having no knowledge of the allegation above.

On 10/17/2025 between the hours of 4:11pm - 4:20pm LPA conducted a records review and observed the following: the department did not receive a LIC 625: Serious/Unusual Incident Report in regard to Resident 13 (R13) shaking from fever and having chills. On 10/17/25 LPA reviewed the staff schedule (dated on 09/05/2025), and observed the following: during the AM shift two (2) caregivers in Units 1 and Unit 4, three (3) caregivers in Unit 2, one (1) caregiver in Units 3 and Unit 5. During the PM shift in Unit 1, Unit 3 , and Unit 5 - two (2) caregiver each were scheduled to work. In Unit 4 - one (1) caregiver is scheduled to work.

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).
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Zina Brown
LICENSING EVALUATOR SIGNATURE:

DATE: 10/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 11-AS-20250909103914
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: 10/20/2025
NARRATIVE
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Allegation: Licensee did not ensure resident records were maintained and readily available for emergency medical staff
It is being alleged that facility staff are not properly trained to communicate with emergency medical staff.

On 08/11/2025, LPA interviewed Administrator (A1) regarding the allegation. A1 denied the allegation. A1 stated when emergency responders requested information for the resident, it is unknown what records were readily available for the first responders. A1 stated the Licensed Nurses and MedTech staff are trained and aware of where the medical chart is located, which includes the physician’s report, emergency contacts, insurance, and medication lists. A1 added that staff are instructed to provide this information upon request from emergency medical personnel.

On 09/10/2025 and on 10/13/2025, LPA Brown conducted interviews with Staff (S1- S4) regarding the allegation. 3 out 4 staff interviewed confirmed of the allegation and stated caregivers are not trained on how to obtain resident records, and it's only Medtechs and/or LVNs who manage records in the event of an medical emergency. 1 out 4 staff denied the allegation and stated staff are trained to locate and provide LIC 602, medication list and facesheet of the resident.

On 09/10/2025, between the hours of 10:17am - 11:42am LPA Brown conducted interviews with Residents 1-12 (R1-R12) regarding the allegation above. 9 of 12 residents interviewed reported being unaware of the allegation and stated not knowing if the facility has in their file their doctors name, list of medication and family contact information. 3 of 12 residents interviewed denied the allegation and stated they know the facility has their personal record on file.

On 10/17/2025 between the hours of 4:20pm, LPA conducted a records review and observed that there is no training on file for staff to ensure resident record are maintained and readily available for emergency first responders.

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).
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Zina Brown
LICENSING EVALUATOR SIGNATURE:

DATE: 10/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 11-AS-20250909103914
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: 10/20/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/24/2025
Section Cited
CCR
87211(a)(1)
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Reporting Requirements(a)(1)Each licensee shall submit serious incident reports to. . . the Department may require, including the following: (1) A written report shall be submitted to the licensing agency & to the person responsible for the resident within 7 days of the occurrence of any of the events.
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The facility shall will submit a serious incident reports for the incident that occur on 09/09/2025 with the resident who had symptoms of chill and fevers. The report must be fax to 424-544-1016 to department by POC due date.
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This requirement was not met as evidenced by: based observation, LPA observed that the facility did submit a LIC 624 to the department within 7 day of incident occurring
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Type B
10/27/2025
Section Cited
CCR
87411(d)(5)
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Personnel Requirements - General (d) All personnel shall be given on the job training or have related experience in the job assigned to them. This training &/or related experience shall provide knowledge of & skill in the following: (5) Knowledge necessary in early signs of illness & the need for professional help.
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The facility will conduct an in service training for all staff to be trained on how to provide all necessary documentation needed upon request by emergency first responders. Also the facility shall create form to be signed by the emergency first responders for proof of receiving resident records before . . .
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This requirement was not met as evidenced by: based on observation and interview staff did not provide emergency first responders with the proper documentation such as medical insurance card, primary care physician information, etc. needed for the resident to be admitted to the hospital
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transporting the resident to the hospital. The facility will submit proof of staff in-service training with signatures and the proof of resident record form provided to emergency first responders to department by POC due date via email Zina.Brown@dss.ca.gov
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: Zina Brown
LICENSING EVALUATOR SIGNATURE:

DATE: 10/20/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 4