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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 392700352
Report Date: 06/03/2022
Date Signed: 06/03/2022 03:11:25 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/06/2022 and conducted by Evaluator Bruce Jacobs
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20220406133344
FACILITY NAME:BRICKS COMMUNITY CARE HOMEFACILITY NUMBER:
392700352
ADMINISTRATOR:LIMBRICK, ANTHONYFACILITY TYPE:
735
ADDRESS:3917 MARCHESOTTI WAYTELEPHONE:
(209) 362-5600
CITY:STOCKTONSTATE: CAZIP CODE:
95205
CAPACITY:4CENSUS: 3DATE:
06/03/2022
UNANNOUNCEDTIME BEGAN:
09:10 AM
MET WITH:Anthony Limbrick, AdministratorTIME COMPLETED:
11:00 AM
ALLEGATION(S):
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Staff failed to secure resident in vehicle.
Resident sustained fracture
Staff failed obtain medical attention.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Bruce Jacobs arrived at the facility and met with Facility Administrator Anthony Limbrick to deliver the investigative findings on the above allegations. This investigation was conducted by the Department and consisted of site inspections to the facility to conduct interviews with the facility administrator, staff, residents and other witnesses. The Investigator and LPA obtained and reviewed copies of the resident's (R-1) file, medical reports and additional documentation.

This investigation concluded that the facility staff (S-1) took two clients on an outing to the park in her car on March 27, 2022. While leaving the park, staff failed to properly secure resident (R-1) in the back seat of the car. The car door was open and the resident's feet were dragging outside of the car. The resident's foot was run over and he suffered multiple fractures to his left foot. Staff did not report the injury to the facility administrator and finished the shift without properly evaluating or documenting the injury or notifying the administrator of any concerns. The resident was sent to the day program the following day and it was at the day program that the extent of the injuries to the resident's foot were realized and emergency services were contacted for the resident.

Continued

Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Bruce Jacobs
LICENSING EVALUATOR SIGNATURE:

DATE: 06/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 4
Control Number 27-AS-20220406133344
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: 06/03/2022
NARRATIVE
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As a result of this investigation, Licensing has determined the above allegations are (S) Substantiated - A finding that the complaint is Substantiated means that the allegation is valid because the preponderance of the evidence standard has been met. The following deficiencies are cited on 9099-D, per Title 22 Regulations, Division 6.

At the time of the conclusion of this complaint investigation, the issuance of a Civil Penalty was still being determined. However, the Licensee was informed that a Civil Penalty may be assessed based on Health & Safety Code section 1569.49.

Exit interview conducted and report provided. Appeals rights printed
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Bruce Jacobs
LICENSING EVALUATOR SIGNATURE:

DATE: 06/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 27-AS-20220406133344
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/03/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/10/2022
Section Cited
CCR
80078(a)
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Responsibility for Providing Care and Supervision a) The licensee shall provide care and supervision as necessary to meet the client's needs. This requirement was not met as evidenced by: On 3/27/22, care staff (S-1) took the resident (R-1) to the park on an outing. When leaving the park in the car, the staff failed to ensure the resident was safely secured in the back
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Plan of Correction: The facility conducted an internal review of the incident, determined the staff was negligent and the staff was terminated on 04/01/22. The facility administrator will conduct in-service training with all staff on the responsibilities of care and supervision and on proper reporting requirements. All staff will have driver's safety training.
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seat of the car. The staff started to drive off with the resident's feet still out of the car and the resident's foot was run over and he suffered multiple fractures to his foot. The staff did not properly evaluate the extent of the injuries and did not inform the administrator of the incident. This poses an immediate health and safety risk to clients in care.
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Type A
06/10/2022
Section Cited
CCR
80075(a)
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Health Related Services a) The licensee shall ensure that each client receives necessary first aid and other needed medical or dental services, including arrangement for and/or provision of transportation to the nearest available services. This requirement was not met as evidence by: Facility staff failed to properly evaluate an injury to a resident. The
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Plan of Correction: The staff responsible for the incident and injury was terminated. The facility administrator will conduct in-service training with all staff on the responsibilities of care and supervision and on providing medical care for the residents.
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staff has run the resident's foot over with her car and then did not properly check the injuries, report the injury or seek medical attention for the client. The resident had multiple fracture of his foot. This poses an immediate health and safety risk to clients in care.
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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.
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Bruce Jacobs
LICENSING EVALUATOR SIGNATURE:

DATE: 06/03/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 27-AS-20220406133344
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/03/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/04/2022
Section Cited
CCR
80065(m)
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Personnel Requirements .(l) Personnel shall provide for the care and safety of persons without physical or verbal abuse, exploitation or prejudice. m) All personnel shall be instructed to report observations or evidence of violations of any of the personal rights specified in Section 80072 and/or any of the personal rights provisions of Chapters 3 through 7.
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Plan of Correction: The facility conducted an internal review of the incident, determined the staff was negligent and the staff was terminated. The facility administrator will conduct in-service training with all staff on the responsibilities of care and supervision and on the personnel requirements for the residents' care.
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his requirement was not met as evidenced by: On 03/27/22. a care staff (S-1) did not secure a resident in the car and the resident's foot was run over by the car. The staff was fired due to this negligence. The staff never reported the incident and injury and did not fulfil the personnel requirements of ensuring the resident's safety and reporting this incident as required.
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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.
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Bruce Jacobs
LICENSING EVALUATOR SIGNATURE:

DATE: 06/03/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2022
LIC9099 (FAS) - (06/04)
Page: 4 of 4