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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 392700352
Report Date: 05/01/2024
Date Signed: 05/01/2024 03:00:02 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/10/2024 and conducted by Evaluator Michael Bilger
COMPLAINT CONTROL NUMBER: 27-AS-20240410082935
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: 2DATE:
05/01/2024
UNANNOUNCEDTIME BEGAN:
01:25 PM
MET WITH:Shukarri HarrisonTIME COMPLETED:
03:15 PM
ALLEGATION(S):
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Staff is utilizing room commonly used for other purposes
as a bedroom for resident
INVESTIGATION FINDINGS:
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On 5-1-24 at 1:25pm, Licensing Program Analyst (LPA) Michael Bilger arrived unannounced to continue investigation of the complaint allegation noted above. LPA met with DIrect Support Professional (DSP) Shukarri Harrison (S1) and explained the purpose of the visit. Administrator Anthony Limbrick was made aware of LPA's visit and purpose via phone. During this investigation, LPA conducted interviews with Administrator via phone. LPA also conducted facility observation, and reviewed individual program plan (IPP) for resident1 (R1).
Based on interview and observation, it was determined that facility Administrator had utilized a personal storage space area located in the bedroom belonging to R1. Items placed in this area include old facility files. These items were not placed in a storage space available for facility equipment and supplies, and instead placed in the storage area used to meet the requirements under Chapter 6, Section 85088(c)(3).

{Cont on 9099C}
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Michael Bilger
LICENSING EVALUATOR SIGNATURE:

DATE: 05/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2024
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 3
Control Number 27-AS-20240410082935
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: BRICKS COMMUNITY CARE HOME
FACILITY NUMBER: 392700352
VISIT DATE: 05/01/2024
NARRATIVE
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Upon further review and interview, it was revealed that there is no existing agreement between Licensee and R1 or R1’s responsible person to utilize this storage space for facility storage purposes.

As a result, the preponderance of evidence standard is met, and this allegation is SUBSTANTIATED. Citation is issued and noted on LIC 9099D. Administrator gave permission via phone for staff to sign and acknowledge in his absence. An exit interview was conducted with S1, and a copy of this report was provided to S1. LIC 811 provided. Appeal rights provided.
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Michael Bilger
LICENSING EVALUATOR SIGNATURE:

DATE: 05/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 27-AS-20240410082935
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: BRICKS COMMUNITY CARE HOME
FACILITY NUMBER: 392700352
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/01/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/10/2024
Section Cited
CCR
80087(d)(1)
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80087(d)(1). Building and Grounds. (d)General permanent or portable storage space shall be available for the storage of facility equipment and supplies. (1) Facility equipment and supplies shall be stored in this space and shall not be stored in space used to meet other requirements specified in this chapter and Chapters 2, and 4 through 7.
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Licensee will remove facility files and store in a designated space for facility equipment and supplies. The licensee will send photo proof to LPA by POC due date.

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This requirement was not met as evidenced by: Based on interview, observation and record reviews, Licensee did not ensure proper storage of facility equipment and supplies in that old facility files were placed in personal storage space intended for resident use. This posed a potential health, safety, and resident rights risk for residents in care.
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Licensee will read regulations 80087(d)(1) and 85088(c)(3) and submit a signed declaration of understanding to LPA by POC due date.
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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: Michael Bilger
LICENSING EVALUATOR SIGNATURE:

DATE: 05/01/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3