<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005809
Report Date: 10/02/2024
Date Signed: 10/02/2024 02:31:55 PM


Document Has Been Signed on 10/02/2024 02:31 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868



FACILITY NAME:BRITTA CAREFACILITY NUMBER:
306005809
ADMINISTRATOR:MANGISI, FRANKFACILITY TYPE:
740
ADDRESS:106 S JEANINE WAYTELEPHONE:
(714) 630-4791
CITY:ANAHEIMSTATE: CAZIP CODE:
92806
CAPACITY:6CENSUS: DATE:
10/02/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
12:56 PM
MET WITH:Norkisa Baladez-CaregiverTIME COMPLETED:
02:46 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On this day Licensing Program Analyst (LPA) Alvaro Ramirez, Jr. made an unannounced Plan of Correction (POC) visit in conjunction with the Required 1 Year Inspection and citations issued on September 16, 2024. LPA was greeted and granted entry into the facility by Caregiver Norkisa Baladec and explained the reason for the visit.

On 09/17/24, AD failed to correct the following:


*Deficiency cited under Title 22 Regulation 87456(a)(2) pertaining to Evaluation of Suitability for Admission. As of 10/02/24, Deficiency cited under Title 22 Regulation pertaining to Evaluation of Suitability for Admission has been CLEARED. Licensee has completed the pre-admission appraisal for two residents.

On 09/23/24, AD failed to correct the following:
*Deficiency cited under Health and Safety Code 1569.618(c)(3) pertaining to Other Provisions. As of 10/02/24, Deficiency cited under Health and Safety Code pertaining to Other Provisions has been CLEARED. LPA observed that the cardiopulmonary resuscitation (CPR) training and first aid training cards expired on September 2026.

On 09/23/24, AD failed to correct the following:
*Deficiency cited under Health and Safety Code 1569.625(b)(2) pertaining to Other Provisions ( training requirements shall also include an additional 20 hours annually). As of 10/02/24, Deficiency cited under Health and Safety Code pertaining to Other Provisions has been not been CLEARED; a Deficiency and Civil Penalty was issued today.


CONTINUED ON LIC809-C...

SUPERVISOR'S NAME: Sheila SantosTELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME: Alvaro Ramirez Jr.TELEPHONE: 714-705-6007
LICENSING EVALUATOR SIGNATURE:
DATE: 10/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/02/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: BRITTA CARE
FACILITY NUMBER: 306005809
VISIT DATE: 10/02/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
On 09/23/24, AD failed to correct the following:
*Deficiency cited under Title 22 Regulation 87468(c)(2)(A) pertaining to Personal Rights of Residents. As of 10/02/24, Deficiency cited under Title 22 Regulation pertaining to Personal Rights of Residents has been CLEARED.

Based on the observations made during today's visit, deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations.

An exit interview was conducted with Administrator (AD) Frank Mangisi and a copy of this report along with the LIC809D and Appeal Rights were provided at the time of this visit.
SUPERVISOR'S NAME: Sheila SantosTELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME: Alvaro Ramirez Jr.TELEPHONE: 714-705-6007
LICENSING EVALUATOR SIGNATURE:

DATE: 10/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2024
LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 10/02/2024 02:31 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868


FACILITY NAME: BRITTA CARE
FACILITY NUMBER: 306005809

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/02/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/18/2024
Section Cited
HSC
1569.625(b)(2)

1
2
3
4
5
6
7
(2) In addition to paragraph (1), training requirements shall also include an additional 20 hours annually, eight hours of which shall be dementia care training, as required by subdivision (a) of Section 1569.626, and four hours of which shall be specific to postural supports, restricted health conditions
1
2
3
4
5
6
7
Licensee to email updated trainings for S1 and S2 by POC due date.
8
9
10
11
12
13
14
, and hospice care as required by subdivision (a) of Section 1569.696. This requirement is not met as evidenced by: Based on interviews and record review, Staff 1 (S1) and (S2) have not completed the trainings. This poses a potential health, safety or personal rights risk to persons in care.
8
9
10
11
12
13
14

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
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: Sheila SantosTELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME: Alvaro Ramirez Jr.TELEPHONE: 714-705-6007
LICENSING EVALUATOR SIGNATURE:
DATE: 10/02/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/02/2024
LIC809 (FAS) - (06/04)
Page: 3 of 3