392700352-9-12-2022-27-AS-MBIR-CJ7V3C-20220912160431

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 392700352
Report Date: 09/12/2022
Date Signed: 09/12/2022 04:05:22 PM

Document Has Been Signed on 09/12/2022 04:05 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

FACILITY NAME:	BRICKS COMMUNITY CARE HOME		FACILITY NUMBER:	392700352
ADMINISTRATOR:	LIMBRICK, ANTHONY		FACILITY TYPE:	735
ADDRESS:	3917 MARCHESOTTI WAY		TELEPHONE:	(209) 362-5600
CITY:	STOCKTON	STATE: CA	ZIP CODE:	95205
CAPACITY: 4		CENSUS: 4	DATE:	09/12/2022
TYPE OF VISIT:	Office	UNANNOUNCED	TIME BEGAN:	03:00 PM
MET WITH:	Anthony Limbrick		TIME COMPLETED:	04:02 PM

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On 9-12-22 at 3:00pm, regional office conducted an informal meeting with facility to discuss recent citations issued and additional concerns. This meeting was held virtually via Teams Meeting. Present at the meeting were Licensing Program Manager (LPM) Liza King, Licensing Program Analyst (LPA) Michael Bilger, and Administrator Anthony Limbrick. Topics in this meeting included the following: (1) Care and Supervision, (2) Health Related Services, and (3) Personnel Requirements.

On 6-3-22, a citation was issued to licensee for Section 80078(a) Responsibility for providing care and supervision due to an incident occurring on 3/27/22 in which Resident1 (R1) sustained multiple fractures of the foot after being driven over by a staff member who did not ensure R1 was secured safety in automobile which posed an immediate health and safety risk for R1.

On 6-3-22 a citation was issued to licensee for Section 80075(a) Health related services due to an incident which occurred on 3-27-22 in which R1 sustained injuries after his foot was driven over by a staff member. According to citation written staff did not properly check and report R1’s injury.

On 6-3-22, a citation was issued to licensee for Section 80065(m) Personnel Requirements due to an incident which occurred on 3-27-22 in which R1 sustained injuries after his foot was driven over by a staff member. Citation states staff member did not report the incident and injury in order to fulfill the requirements of this section.

LPM and LPA discussed the importance of proper staff selection and training as well as the necessity to report incidents to Department as required per regulations.

Regional office is requesting the following documents to be submitted no later that 9-16-22:

1. Updated LIC 500

{Cont. on 9099C}

SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Michael Bilger
LICENSING EVALUATOR SIGNATURE:	DATE: 09/12/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2022

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

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

FACILITY NAME: BRICKS COMMUNITY CARE HOME	FACILITY NUMBER: 392700352
	VISIT DATE: 09/12/2022

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2. Updated LIC 308 in case of Administrator’s absence

3. Current plan of correction (POC) material related to above citation has been submitted to Department for review

Department will conduct quarterly unannounced visits to monitor and address the following but not limited to: (1) Resident rights, (2) Driver’s safety training, (3) Reporting requirement training, (4) Training on when to provide medical care. LPM and LPA notified Administrator that future non-compliance regarding the above and other regulatory components may result in additional citation, civil penalties, and a non-compliance conference.

No citations issued today. An exit interview was conducted with Anthony Limbrick and a copy of this report was emailed to Anthony with request for return with signature.

SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Michael Bilger
LICENSING EVALUATOR SIGNATURE:	DATE: 09/12/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2022

LIC809 (FAS) - (06/04)

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