198320417-8-26-2024-11-AS-SCIS-DC53GA-20241219171401

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198320417
Report Date: 07/15/2024
Date Signed: 08/26/2024 09:46:10 AM

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
07/11/2024 and conducted by Evaluator Felisa Shirley

COMPLAINT CONTROL NUMBER: 11-AS-20240711155146

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: 70	DATE:	07/15/2024
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Neil Chandra, Resident Service Director		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Licensee is not isolating COVID positive resident(s).

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 7/15/24.
On 7/15/24 Licensing Program Analyst (LPA) Felisa Shirley, conducted an unannounced complaint visit. LPA met with the Resident Services Director, Neil Chandra and explained the purpose of today's visit and was granted entry.

The investigation consisted of the following: On 7/15/24 LPA Shirley toured first floor of facility for resident interviews. LPA also requested and reviewed copies of the following records: Staff Roster, Resident Roster, Resident file, Face Sheet, Id and Emergency Info, Id card & Medical ID info, Preplacement Appraisal, Physician’s Report, MAR’s, Physician’s Orders, ActiveCare Living – admissions Disclosure Statement, House Rules, Emergency In-House Doctor Authorization, and Order Summary Report.
Investigation revealed the following:

Con’d on 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Felisa Shirley
LICENSING EVALUATOR SIGNATURE:	DATE: 07/15/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2024

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-20240711155146

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: 07/15/2024

NARRATIVE

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Allegation: Licensee is not isolating COVID-19 positive resident(S)

It is being reported that this facility is not properly isolating Covid-19 positive residents. There were visitors to this facility on 7/4/24 who later tested positive for Covid –19. Facility staff was notified on 7/5/24. During visit on 7/15/24 LPA Shirley interviewed residents who were exposed to the visitors and observed that they were masked, in their room and learned that they had been asked to remain in their room and not to join other residents in the dining room until their PCR test results were returned and reviewed. LPA observed that the exposed residents were more than 6 feet apart. LPA Shirley learned that they had been in their room for at least a week. The Resident Services Director stated during interviews that their protocol was to isolate the resident, notify the family and follow the physician’s orders.

LPA Shirley interviewed staff 1-8 (S1-S8), and asked, does this facility staff isolate covid-19 positive resident(s)? Of those interviewed, 5 out of 8 answered yes. LPA Shirley interviewed residents 1-7 (R1-R7). R-8 was not available for interview. LPA ask, does this facility staff isolate Covid-19 positive residents. Of those interviewed, 2 out of 7 answered No.

Based on information gathered, the department did not find sufficient evidence to support allegation of, "License is not isolating COVID-19 positive resident(s)”. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is Unsubstantiated.

An exit interview was conducted and a copy of the LIC 9099 was provided to Receptionist, Stephanie Rubio.

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Felisa Shirley
LICENSING EVALUATOR SIGNATURE:	DATE: 07/15/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2024

LIC9099 (FAS) - (06/04)

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