198320417-12-10-2025-11-AS-JHAD-DPR2WR-20251226164556

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198320417
Report Date: 12/10/2025
Date Signed: 12/10/2025 12:07:09 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
10/08/2025 and conducted by Evaluator Zina Brown

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20251008154333

FACILITY NAME:	BRITTANY HOUSE		FACILITY NUMBER:	198320417
ADMINISTRATOR:	JOEL NIBLETT		FACILITY TYPE:	740
ADDRESS:	5401 E CENTRALIA ST		TELEPHONE:	(562) 421-4717
CITY:	LONG BEACH	STATE: CA	ZIP CODE:	90808
CAPACITY:	170	CENSUS: 119	DATE:	12/10/2025
		UNANNOUNCED	TIME BEGAN:	08:54 AM
MET WITH:	Joel Niblett, Administrator		TIME COMPLETED:	12:15 PM

ALLEGATION(S):

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Staff did not provide resident's authorized representative with an itemized list of charges
Resident's medical tube was pulled out due to staff neglect resulting in resident needing to go to the hospital

INVESTIGATION FINDINGS:

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On 12/10/2025 at 8:54am, Licensing Program Analyst (LPA) Zina Brown conducted a subsequent visit at this facility to deliver the complaint findings for the allegations above. During today’s visit, at 11:15 am, LPA met with Joel Niblett (Administrator) and explained the purpose of the visit.

The investigation consisted of the following: On 10/13/2025, LPA interviewed with Administrator (A1) and Staff (S1-S9) & received the following documents: Resident Roster (received 10/13/2025), Staff Roster (dated 10/13/2025), Resident #1 (R1's) documents such as LIC 601 Personnel Record (dated 07/28/2025), LIC 602: Physician Report (dated 07/25/2025), LIC 603: Pre-Placement Appraisal (dated 7/25/2025), LIC 604: Admission Agreement (dated 07/25/2025), Invoice of Rent (dated 09/01/2025 & 10/01/2025), Receipt of Payment, After Summary Visit from Kaiser (Dated 09/13/2025), Assessment Plan 07/25/2025, Discharge Report (dated 09/12/2025), Medication Administrator Record (dated 09/2025) and Communication Logs (dated 09/03/2025, 09/13/2025,09/17/2025, & 09/29/2025).

Report continues on LIC 9099-C

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Zina Brown
LICENSING EVALUATOR SIGNATURE:	DATE: 12/10/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/10/2025

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20251008154333

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: 12/10/2025

NARRATIVE

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The investigation revealed the following:
Allegation: Staff did not provide resident's authorized representative with an itemized list of charges

It is alleged that the facility did not provide Resident 1's representative with an itemized list of additional care services at the time of admission.

On 10/13/2025, between the hours of 11:15am - 12:09pm, LPA interviewed Administrator (A1) regarding the allegation. A1 neither confirmed nor denied the allegation. A1 stated based on the physician report determines how charges and extra care fees are explained and to the residents and their representative. A1 responded not applicable and did not provide the process.

On 10/13/2025, between the hours of 9:04am - 1:00pm LPAs conducted interviews with Staff (S1-S9). 8 of 9 staff were unaware of the allegation as the caregivers have no knowledge of families being given itemized list of charges or a breakdown of extra care services.

1 of 9 staff did not confirm nor deny the allegation and S9 stated not generating the statement for invoices as that was the role of someone else who no longer works for the facility. However, Grandview does the billing for the residents. However, S9 stated its two care levels which is 17 (is when resident can still feed themselves, some in a wheelchair and ambulate) and level 22 (handfeeding, full care assist). S9 also stated R1 was level 22 because R1 couldn’t sit up without assistance and needed repositioning and transfers.

On 10/13/2025 between the hours of 12:30pm - 12:45pm & on 12/03/2025 between the hours of 4:00pm -5:00pm, LPA conducted a records review and observed the following: receipts for care $7,200 - dated 07/28/2025 , for deposit (#4255) $500 - dated 07/25/2025, for deposit (#4258) $500 - dated 08/01/2025, for other half of pay (#4261) - $500 dated 08/09/2025, for September 2025 rent (#4267) $8,825. - dated 09/02/2025. Also based on Resident 1's Admission Agreement (signed on 07/29/2025) R1's room rate for a semi-private studio cost $5,000 with an additional miscellaneous care fee of $2,200 which comes to a total of $7,200. The review of the Admission Agreement does not itemize nor specify what the miscellaneous care service consist of nor rates of care services. LPA also review the invoices (statement dates 09/01/2025 and 10/01/2025). The review of both invoices show multiple dates and charges for room and board for $7200 and does not itemize the current months charges.

Based on LPAs observations and interviews which were conducted and the records that were reviewed, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED under California Code of Regulations, Title 22, Division 6 and Chapter 8 are being cited on the attached LIC 9099D.

Report continues on LIC 9099-C

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Zina Brown
LICENSING EVALUATOR SIGNATURE:	DATE: 12/10/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/10/2025

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20251008154333

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: 12/10/2025

NARRATIVE

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The investigation revealed the following:
Allegation: Resident's medical tube was pulled out due to staff neglect resulting in resident needing to go to the hospital.

It is alleged that the facility failed to provide adequate supervision and medical care, resulting in the resident’s gallbladder (cholecystostomy) tube being pulled out on two separate occasions, which led to hospitalizations and infection.

On 10/13/2025, between the hours of 11:15am - 12:09pm, LPA interviewed Administrator (A1) regarding the allegation. A1 denied the allegation. A1 stated Resident 1 (R1) did not have a g-tube and stated the resident was not on hospice nor receiving home health but was on Kaiser.

On 10/13/2025, between the hours of 9:04am - 1:00pm, LPAs conducted interviews with Staff (S1-S8). 3 of 9 staff confirmed the allegation and stated by S2 observing R1 with a g-tube upon the partner of R1 informing staff that the g-tube was pulled out. S4 stated upon R1 first being at the facility he didn't have a g-tube but after the third time of R1 going to the hospital he returned to the facility with a g-tube. S8 stated R1 had a g-tube for 2-3 weeks which the caregiver did not know that R1 pulled out the g-tube himself. 1 of 9 staff denied the allegation and stated by S5 that R1 did not have a g-tube while residing at the facility.

3 of 9 staff were unaware of the allegation and stated having no knowledge of R1 having a g-tube. 2 of 9 staff didn't not confirm nor deny the allegation and stated upon admission resident never had a tube. However it was discovered R1 had some type gallbladder infestation which required him to have some kind of tube which he pulled out himself which isn't a g-tube.

On 12/10/2025, the LPA conducted a records review and observed the following: In R1’s file, there was no documented care plan or approved exception request on file from the Department. The LPA observed a Kaiser Permanente discharge note dated 09/13/2025 indicating that R1 had a cholecystostomy tube. However, there was no documentation of a restricted health care plan or reappraisal related to the cholecystostomy tube. Additionally, the post-discharge plan of care did not document the presence of the cholecystostomy tube or the required care.

An exit interview was conducted with Administrator Joel Niblett and a copy of this report was provided with appeal rights.

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Zina Brown
LICENSING EVALUATOR SIGNATURE:	DATE: 12/10/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/10/2025

LIC9099 (FAS) - (06/04)

Page: 4 of 4

Control Number 11-AS-20251008154333

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: 12/10/2025

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 01/26/2026 Section Cited CCR 87609(b)(2)	1 2 3 4 5 6 7	Allowable Health Conditions and the Use of Home Health Agencies(b)Incidental medical care may be provided to residents through a licensed home health agency provided the following conditions are met: (2) The licensee provides the supporting care & supervision needed to meet the needs of the resident receiving home health care.	1 2 3 4 5 6 7	The facility will submit a plan to the department outlining how the facility will be in compliance with Title 22 regulations.
	8 9 10 11 12 13 14	Based on interviews and record review, the facility did not have a restricted health care plan for the cholecystostomy tube, and staff were not informed of the type of tube inserted or the required care & supervision need.	8 9 10 11 12 13 14	The facility will submit the proof of correction to the CCLD/El Segundo ASC Office via fax at 424-544-1016 Attn: Zina Brown or via email at zina.brown@dss.ca.gov by the POC due date.
Type B 01/26/2026 Section Cited CCR 87507(g)(3)(B)(1)	1 2 3 4 5 6 7	Admission Agreements...(B)Rate for additional items and services, including: (1) A comprehensive description of and the corresponding fee schedule for all additional items and services not included in the fees for basic services shall be listed.	1 2 3 4 5 6 7	The facility will submit a updated resident Admission Agreement which will be in compliance with Title 22 regulations for the Department to review.
	8 9 10 11 12 13 14	Based on record review and interviews, the licensee did not ensure R1 admission agreement contained a comprehensive description of additional fees or the fee schedule for services not included in the basis services.	8 9 10 11 12 13 14	The facility will submit the proof of correction to the CCLD/El Segundo ASC Office via fax at 424-544-1016 Attn: Zina Brown or via email at zina.brown@dss.ca.gov by the POC due date.

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: 12/10/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/10/2025

LIC9099 (FAS) - (06/04)

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