198320417-5-22-2024-11-AS-SCIS-D9H23J-20240926170226

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198320417
Report Date: 05/22/2024
Date Signed: 05/22/2024 02:19:49 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
03/18/2024 and conducted by Evaluator Elvira Gonzalez

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20240318111845

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:	DATE:	05/22/2024
		UNANNOUNCED	TIME BEGAN:	09:06 AM
MET WITH:	Neio Chandra		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Staff are not administering resident's medications as prescribed.
Staff are mismanaging resident's medications.

INVESTIGATION FINDINGS:

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On 05/22/2024, Licensing Program Analyst (LPA) Elvira Gonzalez conducted an unannounced subsequent complaint visit to this facility to conclude complaint investigation and deliver findings. LPA met with Resident Services Director Neio Chandra, and the purpose of today’s visit was explained.

The investigation consisted of the following: On 03/25/24, LPA Gonzalez conducted a tour of the medication room, interviewed staff #1-#5 (S1-S5), reviewed resident files, received documents pertinent to the investigation, and requested additional documents which were provided to LPA via email on 03/28/24. On 04/09/24, LPA Gonzalez interviewed residents #2-#7 (R2-R7), LPA was unable to interview resident #1 (R1) due to medical conditions. LPA also reviewed resident file and requested copies of documents. On 05/22/24, LPA interviewed staff #6-#8 (S6-S8).

Continued on LIC9099-C

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Stephanie Cifuentes	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Elvira Gonzalez	TELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 05/22/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2024

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-20240318111845

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: 05/22/2024

NARRATIVE

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The documents received and reviewed are the Staff Roster, Resident Roster, resident’s Physician’s Reports, Residents Physicians Orders, and Resident Appraisals, and residents MARs (Medication Administration Records).

INVESTIGATION REVEALED THE FOLLOWING:

Allegation: Staff are not administering resident's medications as prescribed.
It is alleged that staff failed to administer medications to a resident as prescribed. It is also alleged that a resident has had extended times without vital medications which have led to the resident experiencing extreme anxiety and hallucinations.

0n 05/22/24, the department audited residents MAR (dated: 02/01/24 - 02/29/24 and 03/01/24 - 03/31/24) and revealed that a Not Applicable note was noted for 18 out of 29 days in February and 11 out of 31 days in March. On 05/22/24 at 10:30 AM, (1) out of (8) staff that were interviewed by the Department were aware of the error. S8 admitted to knowing about the medication not being dispensed as prescribed to the resident. LPA Gonzalez asked S8, what happened on 03/15/24 and 03/16/24 with R1? S8 stated they couldn’t give the resident their medication those days because they were waiting on the refills. S8 stated that they wrote not applicable on the QuickMAR note section but forgot to note the reason for not applicable. LPA then asked S8 if the not applicable noted on the rest of the days in the MAR meant the same thing, and S8 stated that it did mean that the resident was not given their medication(s) as prescribed and said this won’t happen again.

On 04/09/24, LPA Gonzalez interviewed residents #2 - #7 (R2 -R7). Five (5) out of six (6) residents interviewed stated that the staff at this facility dispense their medication as prescribed by their physician, and (6) out (6) residents interviewed stated they have not missed any medication dosage.

Based on evidence gathered, interviews conducted, and records reviewed, the preponderance of evidence standard has been met; therefore, the above allegation is found to be SUBSTANTIATED.

Continued on LIC9099-C

SUPERVISOR'S NAME: Stephanie Cifuentes	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Elvira Gonzalez	TELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 05/22/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2024

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20240318111845

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: 05/22/2024

NARRATIVE

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Allegation: Staff are mismanaging resident’s medications.
It is alleged that staff are mismanaging resident’s medications. It is also alleged that a resident had not had their Memantine medication in a week, because the medication was ordered but it had not arrived yet.

On 04/09/24 LPA interviewed witness #1 (W1), R6’s daughter. Interview communicated that they feel there is not enough staff at this facility to provide for the needs of the residents. W1 stated that R6 does not get their medications on time or when needed. W1 stated that staff has advised them on several occasions that R6 did not get their medication because of the facility waiting for the medication to be refilled. On 05/22/24 at 10:30 AM, (1) out of (8) staff that were interviewed by the Department were aware of the error. S8 stated that they are aware the resident missed their medications on numerous times because they were out of medicine and were waiting on the medication to be refilled. S8 stated that in the past they have made the mistake of advising the nurse (which is responsible for refilling the resident’s medication) last minute or when the resident did not have any more medication, and that would cause a delay in receiving the new medication timely, which would cause the resident to go days without their medication(s).

Based on evidence gathered, interviews conducted, and records reviewed, the preponderance of evidence standard has been met; therefore, the above allegation is found to be SUBSTANTIATED.

According to the California Code of Regulations (Title 22, Division 6, Chapter 8) the following deficiencies have been observed and citations issued (ref. LIC 9099D).

An exit interview has been conducted and a copy of the Complaint Report and Appeal Rights was provided to Resident Services Director Neil Chandra.

SUPERVISOR'S NAME: Stephanie Cifuentes	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Elvira Gonzalez	TELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 05/22/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2024

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20240318111845

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: 05/22/2024

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 06/05/2024 Section Cited CCR 87464(f)(4)	1 2 3 4 5 6 7	87464(f)(4) Personal assistance and care as needed by the resident and as indicated in the pre-admission appraisal, with those activities of daily living such as dressing, eating, bathing and assistance with taking prescribed medications, as specified in Section 87608, Postural Supports. This was not met as evidence by based on records reviewed and interviews, med tech failed to give medication to resident which poses a potential health, safety risk to persons in care.	1 2 3 4 5 6 7	Licensee will provide a training for all med techs to attend regarding policies and procedures for medications. Licensee will send LPA Gonzalez the sign in sheet and description of the type of training given by POC due date 06/05/24.
Type B 06/05/2024 Section Cited CCR 87465(a)(2)	1 2 3 4 5 6 7	87465(a)(2) Incidental Medical and Dental Care - A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care, by compliance with the following: The licensee shall provide assistance in meeting necessary medical and dental needs… This was not met as evidence by based on records reviewed and interviews, med tech admitted to LPA that he was notifying the nurse about refilling medications last minute and that would cause a delay, where resident would go days without medication.	1 2 3 4 5 6 7	Licensee will provide a training for all med techs to attend regarding policies and procedures for medications. Licensee will send LPA Gonzalez the sign in sheet and description of the type of training given by POC due date 06/05/24.
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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.

SUPERVISOR'S NAME: Stephanie Cifuentes	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Elvira Gonzalez	TELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 05/22/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2024

LIC9099 (FAS) - (06/04)

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