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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 392700352
Report Date: 09/27/2023
Date Signed: 09/27/2023 03:20:38 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO AC/SC, 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
08/02/2023 and conducted by Evaluator Kesha Lewis
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20230802132102
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: DATE:
09/27/2023
UNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:LIMBRICK, ANTHONYTIME COMPLETED:
03:30 PM
ALLEGATION(S):
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9
No staff members were present at facility to answer facility's door for residents
Staff failed to meet residents' needs
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Kesha Lewis arrived at the facility unannounced to deliver complaint findings for the above allegations. LPA was greeted by staff licensee joined about 20 minutes later LPA explained the reason for the visit.

Based on documents reviewed, videos the licensee showed LPA lewis and interviews with staff and licensee. the above allegation is SUbSTANTIATED A finding that the complaint allegation is Substantiated means that the allegation is valid because the preponderance of the evidence standard has been met. This poses a potential health, safety, and personal rights risk to residents in care.

California Code of Regulations (Title 22, Division 6, Chapter 8), are being cited on the attached LIC 9099-D.

LPA exit review: 9099 , 9099-D and appeal rights given.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Kesha Lewis
LICENSING EVALUATOR SIGNATURE:

DATE: 09/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2023
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 2
Control Number 27-AS-20230802132102
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO AC/SC, 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: 09/27/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type A
09/28/2023
Section Cited
CCR
80078(a)(1)
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NEGLECT AND LACK OF SUPERVISION -(a) In addition to Section 80078, the following shall apply:
(a)(1) The licensee shall provide those services identified in the client's needs and services plan as necessary to meet the client's needs.
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Licnesee will provide LPA Lewis with an updated LIC 500 to show the is enough staff for the residents by COB 9/28/2023.
Kesha.lewis@dss.ca.gov
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R1 was dropped off at the facility and there was not staff present at the time to care for the resident or let them in the facility. This poses an immitate health, safety, and personal rights risk to residents in care.
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Deficiency Dismissed
Type B
09/28/2023
Section Cited
CCR
85065(b)
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85065-Personnel Requirements. (b) The licensee shall employ staff as necessary to ensure provision of care and supervision to meet client needs.
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Licensee will provide LPA Lewis with an updated LIC 500 to show the is enough staff for the residents by COB 9/28/2023.
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based on interviews with staff and licensee there was no staff at the facility when a resident returned. This poses a potential health, safety, and personal rights risk to residents 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: Kesha Lewis
LICENSING EVALUATOR SIGNATURE:

DATE: 09/27/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2