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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 392700352
Report Date: 03/29/2023
Date Signed: 03/29/2023 03:20:11 PM

Document Has Been Signed on 03/29/2023 03:20 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 HOMEFACILITY NUMBER:
392700352
ADMINISTRATOR:LIMBRICK, ANTHONYFACILITY TYPE:
735
ADDRESS:3917 MARCHESOTTI WAYTELEPHONE:
(209) 362-5600
CITY:STOCKTONSTATE: CAZIP CODE:
95205
CAPACITY: 4CENSUS: 4DATE:
03/29/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
02:19 PM
MET WITH:Anthony Limbrick via phoneTIME COMPLETED:
03:45 PM
NARRATIVE
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Licensing Program Analyst (LPA) Michael Bilger conducted an unannounced case management visit on 3-29-23 at 2:19pm to follow up on a substantiated complaint received on April 4, 2022. LPA Bilger met with the Licensee Anthony Limbrick via phone. LPA explained the reason for the visit. Licensee gave permission for staff member (W1) to sign on his behalf.

On June 3, 2022, the Department concluded a complaint investigation and substantiated an allegation that Staff (S1) failed to secure Resident (R1) in a vehicle. R1 sustained fractures to their feet and S1 failed to obtain medical attention for R1.

The allegations were substantiated, and the licensee was cited for violating California Code of Regulations (CCR) Tile 22, Division 6 § 80078(a) Responsibility of Providing Care and Supervision and (CCR) Tile 22, Division 6 80075(a) Health Related Services for failure to obtain timely medical treatment.

The investigation revealed that, on March 27, 2022, S1 drove R1 and R2 to a nearby park. The residents played basketball at the park. According to an interview, S1 reported that they usually assist R1 into the vehicle, but on this day did not. S1 reported, they started the car and “didn’t look back.” R2 stated, “the car began to move and there was a scrapping sound.” {Cont. on 9099C}

SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Michael Bilger
LICENSING EVALUATOR SIGNATURE: DATE: 03/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/29/2023
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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME: BRICKS COMMUNITY CARE HOME
FACILITY NUMBER: 392700352
VISIT DATE: 03/29/2023
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According to S1, they stopped the car, looked back, and saw that R2 was seated in the backseat with both feet still hanging out of the car. S1 stated that R1 got out of the car and back in by themselves, “limped a little bit” but began walking regularly after the first initial limps. R2 reported, S1 asked that they not tell anyone what had happened. Upon arriving back at the facility, S1 did not provide medical attention nor seek medical attention or report the incident to the Facility Administrator. Staff (S2) observed R1 limping and reported that they only took one sock down of one foot to observe if there was anything wrong, then performed first aid on one small cut. S2 did not document the incident.

The extent of the injuries was not observed until the following day while the client was at their Day Program. Staff at the Day Program and the family observed that the resident’s foot, toes, and ankle were noticeably swollen. The resident was transported from Day Program to the Emergency Room. According to medical records obtained from local acute hospital, R1 sustained a crush injury of the left foot including a closed fracture of first metatarsal bone of the left foot, closed fracture of second metatarsal bone of the left foot, closed fracture of third metatarsal bone of the left foot, closed fracture of fourth metatarsal bone of the left foot, closed fracture of fifth metatarsal bone of the left foot

At the time of the complaint visit, the issuance of a Civil Penalty was still being determined and the licensee was informed that a civil penalty might be assessed based on Health and Safety Code § 1548(f)(1)(A) which states “serious bodily injury means a serious impairment of physical condition, including, but not limited to, the following: loss of consciousness; concussion; bone fracture; protracted loss or impairment of function of any bodily member or organ; a wound requiring extensive suturing; and serious disfigurement.” {Cont. on 9099C}

SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Michael Bilger
LICENSING EVALUATOR SIGNATURE:

DATE: 03/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/29/2023
LIC809 (FAS) - (06/04)
Page: 2 of 3
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: 03/29/2023
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The Department has concluded an analysis and has determined that a Civil Penalty is warranted for Responsibility for Providing Care and Supervision and 80075(a) – failure to seek medical for a serious injury and 80065(m) failure to report a special incident (serious injury). Today, 3-29-23, the Department will be issuing a Civil Penalty per Health and Safety Code 1548(f)(1)(A) for $10,000

An exit interview was conducted, and a copy of the LIC 421D report was provided to Anthony Limbrick and W1. Original copies of the LIC 421D were signed by W1. Appeal Rights listed on the LIC421D were delivered and reviewed with Anthony via phone. Signature on this report acknowledges receipt of these rights, found on page 2 of LIC 421D.

SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Michael Bilger
LICENSING EVALUATOR SIGNATURE:

DATE: 03/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/29/2023
LIC809 (FAS) - (06/04)
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