Inspection Reports for
Brittany House

The visit was triggered by complaint #11-AS-20251118115055. The reporting requirement citation was substantiated but cleared during the visit. The administrator qualifications citation remains with a plan of correction due.

The facility was found not in compliance with Title 22 regulations related to Administrator Qualifications and Reporting Requirements. The reporting requirement citation was cleared during the visit, while the administrator qualifications citation remains with a plan of correction due.

The complaint alleged that staff did not address a resident's change of condition and did not seek medical attention in a timely manner. The allegations were substantiated based on interviews, record reviews, and evidence that the resident's infected toe required amputation due to delayed care.

The investigation substantiated that staff failed to properly observe and address the resident's swollen foot and infected toe, which ultimately required amputation. Staff did not timely notify medical services, and the facility failed to submit required incident reports. Deficiencies were cited and plans of correction discussed.

The visit was triggered by complaint #11-AS-20251118115055. The reporting requirement citation related to the complaint was cleared during the visit. The administrator qualifications citation remains open with a plan of correction due by 02/06/2026.

The facility was found not in compliance with Title 22 regulations related to Administrator Qualifications and Reporting Requirements. The reporting requirement citation was cleared during the visit, while the administrator qualifications citation remains with a plan of correction due.

The complaint alleged staff did not address a resident's change of condition and did not seek medical attention in a timely manner. The investigation found these allegations substantiated. The resident's foot became swollen and infected, leading to amputation of the toe. Staff failed to notify medical services appropriately and did not submit required incident reports. The facility was cited and assessed a civil penalty.

The investigation substantiated both allegations, finding that staff failed to properly observe and respond to a resident's swollen and infected foot, which resulted in the resident's toe being amputated. Deficiencies were cited related to observation of residents and personnel requirements, and a $500 civil penalty was assessed for the serious bodily injury.

The deficiency for criminal background clearance was re-issued with civil penalties being assessed due to 3 of 12 staff not being associated with the facility at the time of inspection, posing an immediate risk to persons in care.

The complaint investigation was triggered by allegations received on 11/07/2025 regarding unqualified staff administering medication, failure to seek timely medical attention, improper incident reporting, and delayed response to call buttons. The investigation included interviews with staff and residents, records review, and observations. The allegations of unqualified medication administration, delayed medical attention, improper reporting, and delayed call button response were substantiated. Allegations related to failure to follow care plans and inaccurate resident records were unsubstantiated.

The investigation substantiated several allegations: unqualified staff administered narcotic medication causing an overdose; facility staff failed to seek timely medical attention; staff did not properly report incidents; and staff did not respond promptly to resident call buttons. Two allegations regarding failure to follow resident care plans and inaccurate resident records were unsubstantiated.

The deficiency related to three staff members not being associated with the facility at the time of inspection was re-issued, with civil penalties being assessed. The deficiency poses an immediate health, safety, or personal rights risk to persons in care.

The complaint investigation was triggered by allegations that unqualified staff administered medication to a resident resulting in overdose, failure to seek timely medical attention, failure to properly report the incident, and failure to respond promptly to resident call buttons. The investigation included interviews with staff and residents, records review, and observations. The allegations regarding medication administration, medical attention, incident reporting, and call button response were substantiated. Allegations about following care plans and record accuracy were unsubstantiated.

The investigation substantiated several allegations including unqualified staff administering narcotic medication causing an overdose, failure to seek timely medical attention, failure to properly report incidents, and failure to respond promptly to resident call buttons. Two allegations regarding following resident care plans and keeping accurate resident records were unsubstantiated.

The facility was found to have multiple deficiencies including staff association and record issues, incomplete medication administration records, personnel training and documentation gaps, water temperature noncompliance, and missing bedroom furniture. The facility environment and safety equipment were generally compliant, but several regulatory violations were cited.

The facility was found to have multiple deficiencies including staff association and training issues, incomplete medication administration records, personnel record deficiencies, water temperature noncompliance, missing bedroom furniture, and lack of required training for direct care staff. Some deficiencies posed immediate or potential risks to residents' health, safety, or personal rights.

The complaint alleged that the facility did not notify the responsible party of resident (R#1) about a scabies outbreak involving resident (R#2). The allegation was substantiated based on records review and interviews.

The investigation found sufficient evidence that the facility staff failed to notify the responsible party of a resident's health condition related to a scabies outbreak, which was substantiated. Documentation and interviews confirmed no notification was made.

The complaint alleged that the facility did not notify the responsible party of resident (R#1) about the scabies outbreak affecting resident (R#2), who shared a room with (R#1). The allegation was substantiated based on interviews and record reviews showing no documentation of notification.

The investigation found sufficient evidence that the facility staff failed to notify the responsible party of a resident's health condition related to a scabies outbreak, which was substantiated. The facility was cited for not meeting reporting requirements under California Code of Regulations Title 22.

The complaint investigation was substantiated based on the finding that the facility retained a resident with an unstageable pressure injury without submitting the required exception request to the department.

The facility retained a resident with an unstageable pressure injury, which is prohibited by Title 22 regulations. The facility failed to submit an exception request to the department to retain this resident, resulting in a cited deficiency.

The complaint investigation was substantiated regarding a resident sustaining an unstageable pressure injury due to staff neglect/lack of supervision. The facility failed to submit the required exception request to retain the resident.

The facility retained a resident with an unstageable pressure injury, which is prohibited by Title 22 regulations, and failed to submit an exception request to the department to retain the resident.

The complaint investigation was substantiated. Allegations included failure to provide an itemized list of charges to the resident's authorized representative and neglect leading to the resident's medical tube being pulled out, causing hospitalizations. The investigation included interviews with staff and administrator, and review of resident records and billing documents.

The investigation substantiated both allegations: the facility did not provide an itemized list of additional care service charges to the resident's representative, and the resident's medical tube was pulled out due to staff neglect, resulting in hospitalizations. The facility lacked a restricted health care plan for the cholecystostomy tube and did not inform staff of required care and supervision.

The complaint investigation was substantiated. Allegations included failure to provide an itemized list of charges to the resident's authorized representative and neglect leading to a resident pulling out a medical tube requiring hospitalization. The preponderance of evidence standard was met based on interviews, record reviews, and observations.

The investigation substantiated both allegations: the facility failed to provide an itemized list of additional care service charges to the resident's representative, and the facility neglected to provide adequate supervision and medical care, resulting in the resident pulling out a cholecystostomy tube leading to hospitalizations. Deficiencies were cited related to lack of a restricted health care plan and incomplete admission agreement regarding additional fees.

The complaint alleged that staff did not address a resident's change of condition and did not seek medical attention in a timely manner. The investigation found these allegations substantiated based on interviews with staff, residents, and a witness, as well as review of facility records and communication logs.

The investigation substantiated that staff failed to address the resident's change of condition, resulting in the resident's toe becoming infected and amputated. Staff also failed to seek timely medical attention for the resident. The facility did not submit required incident reports related to the hospitalization and amputation.

The complaint alleged that staff did not address a resident's change of condition and did not seek medical attention in a timely manner. The investigation found these allegations substantiated based on interviews with staff, residents, and a witness, as well as review of facility records and communication logs. The facility failed to notify medical services appropriately and did not submit required incident reports.

The investigation substantiated both allegations. Staff failed to address the resident's swollen and infected foot, which led to amputation of the toe, and failed to seek timely medical attention. The facility also failed to submit required incident reports related to the resident's hospitalization and amputation.

The visit was complaint-related for Control Number 11-AS-20250909103914. The complaint was substantiated by the finding that the facility did not report the incident as required.

The facility failed to submit a required Serious/Unusual Incident Report (LIC 625) regarding Resident 13 who was shaking from fever and having chills, which is a violation of California Code of Regulation Title 22 Division 6 Chapter 8.

The complaint investigation addressed two allegations: 1) Licensee did not ensure resident records were maintained and readily available for emergency medical staff, which was substantiated. 2) Staff did not seek timely medical attention, which was unsubstantiated.

The investigation substantiated that the licensee did not ensure resident records were maintained and readily available for emergency medical staff, resulting in a citation. The allegation that staff did not seek timely medical attention was unsubstantiated due to insufficient evidence.

The complaint alleged that changes in residents' conditions were going unnoticed leading to hospitalizations. Interviews with residents and staff yielded mixed responses, but record review confirmed lack of reassessment and care planning. The allegation was substantiated.

The investigation found the allegation substantiated based on interviews, record reviews, and observations. Specifically, there was no re-assessment available for a resident returning from the hospital, no care plan for a catheter, and no documentation of staff training in catheter care.

Complaint Control Number 11-AS-20250909103914 was investigated. The facility failed to report the incident as required. No substantiation status explicitly stated.

The facility failed to submit a required Serious/Unusual Incident Report (LIC 625) regarding Resident 13 who was shaking from fever and chills. This failure to report the incident as required resulted in a cited deficiency under California Code of Regulation Title 22 Division 6 Chapter 8.

The complaint was substantiated based on observations and interviews conducted during the investigation. The allegation was that staff did not ensure the resident had access to their call button/pendent.

The investigation substantiated the allegation that a resident did not have access to their call button, which was found in a drawer and later reinstalled on the wall. This posed a potential health, safety, and personal rights risk to the resident.

The complaint was substantiated based on observations and interviews conducted during the investigation. The allegation was that staff did not ensure resident access to the call button/pendent.

The investigation substantiated the allegation that a resident did not have access to their call button, which was found in a drawer and later reinstalled on the wall. This posed a potential health, safety, and personal rights risk to the resident.

The visit was complaint-related for Control Number 11-AS-20251006160920. The facility failed to report the incident as required. Substantiation status is not explicitly stated.

The facility failed to submit a LIC 624 Unusual Incident/Injury Report and a LIC 624A Death Report for Resident 1 within the required timeframe, violating California Code of Regulation Title 22 Division 6 Chapter 8.

The visit was complaint-related for Control Number 11-AS-20251006160920. The deficiency was substantiated as the facility failed to report the incident and death as required.

The facility failed to submit a LIC 624 Unusual Incident/Injury Report for a resident transported to the hospital and a LIC 624A Death Report for the resident's passing, thus failing to report the incident as required by the department.

The complaint investigation was substantiated. Evidence included interviews with staff, residents, and the administrator, as well as records review. One allegation confirmed that staff did not seek timely medical attention for Resident 13, and another confirmed that staff were not trained to provide resident records to emergency medical personnel.

The investigation substantiated both allegations: staff failed to timely call emergency services for a resident exhibiting serious symptoms, and the facility did not ensure staff were properly trained to maintain and provide resident records to emergency responders. Citations were issued for deficiencies related to reporting requirements and personnel training.

The complaint investigation was substantiated for failure to properly address changes in condition of residents. Interviews with residents and staff, as well as record reviews, supported this finding. Other allegations regarding admission procedures and retaining residents beyond their level of care were unsubstantiated.

The investigation substantiated the allegation that facility staff do not properly address changes in condition of residents, noting a lack of re-assessment for a resident which poses a potential health and safety risk. The allegations regarding failure to follow admission procedures and retaining residents beyond their level of care were found unsubstantiated due to insufficient evidence.

The visit was triggered by a complaint investigation (Control 11-AS-20251015105817) concerning the absence of a documented care plan for catheter use.

The inspection found that there was no documented care plan for catheter use, which poses a potential health and safety risk to residents. A deficiency was cited under California Code of Regulation Title 22 Division 6 Chapter 8.

The complaint investigation was substantiated. Evidence included interviews with staff, residents, and the administrator, as well as records review. One allegation confirmed that staff did not seek timely medical attention for Resident 13, and another confirmed that staff were not properly trained to provide resident records to emergency medical personnel.

The investigation substantiated both allegations: staff failed to seek timely medical attention for a resident exhibiting serious symptoms, and the licensee did not ensure resident records were maintained and readily available for emergency medical personnel. Deficiencies were observed and citations issued under California Code of Regulations Title 22, Division 6, Chapter 8.

The complaint investigation was substantiated for failure to properly address changes in condition of residents. Interviews with residents and staff, as well as record reviews, supported this finding. Other allegations regarding admission procedures and retaining residents beyond their level of care were unsubstantiated.

The investigation substantiated the allegation that facility staff do not properly address changes in condition of residents, noting a lack of re-assessment for a resident which poses a potential health and safety risk. The allegations regarding failure to follow admission procedures and retaining residents beyond their level of care were found unsubstantiated due to insufficient evidence.

The visit was triggered by a complaint investigation (Control 11-AS-20251015105817) which revealed the absence of a documented care plan for catheter use.

A deficiency was cited for failure to have a documented care plan for the use of an indwelling urinary catheter, which poses a potential health and safety risk to residents in care.

The complaint alleged that staff were not following proper eviction procedures, specifically that the facility did not want to take resident (R#1) back from the hospital. The allegation was substantiated based on interviews and document review.

The investigation found sufficient evidence to substantiate the allegation that the facility failed to properly assess a resident prior to hospital discharge, resulting in the resident not being able to return to the facility. This posed a potential health and safety risk to residents.

The complaint investigation was substantiated based on records and interviews. The resident (R1) was non-ambulatory with dementia and a fall risk. Staff left R1 unsupervised for approximately 20 minutes, leading to an unwitnessed fall and fracture. Staff also failed to notify the hospice agency or resident's daughter/POA about the resident's pain after the fall.

The investigation substantiated both allegations: staff failed to adequately supervise a resident who was a fall risk, resulting in an unwitnessed fall and a right femoral fracture, and staff did not seek timely medical attention for the resident despite complaints of pain. An immediate civil penalty of $500 was assessed.

The complaint investigation was substantiated for allegations that staff did not provide adequate supervision leading to a resident fall and fracture, and did not seek medical attention for the resident after the fall. The allegation that staff did not prevent the resident from developing a UTI was unsubstantiated.

The investigation substantiated that staff failed to provide adequate supervision, resulting in a resident's fall and fracture, and failed to seek timely medical attention after the fall. However, the allegation that staff did not prevent the resident from developing a UTI was unsubstantiated. An immediate civil penalty of $500 was assessed for the substantiated deficiencies.

The complaint was substantiated. Allegations included staff leaving a resident in soiled clothing and not keeping the resident's room free from odor. Interviews with staff and residents, observations, and record reviews supported the findings. The resident had a history of refusing showers and urinating frequently, which staff attempted to manage despite challenges.

The investigation substantiated both allegations. Staff left the resident in soiled clothing due to the resident's frequent urination and combative behavior, and the resident's room was found to have a strong urine odor and stains on the carpet. Deficiencies were cited related to observation of the resident and maintenance and operation of the facility.

The visit was complaint-related, triggered by Complaint Control Number: 11-AS-20250812125512. The deficiency was substantiated as the facility was found non-compliant with criminal clearance requirements.

The facility was found to be non-compliant with California Code of Regulations Title 22 due to a staff member lacking the required criminal background clearance and not being associated with the facility. A deficiency was cited based on interviews, observations, and record reviews.

The visit was triggered by a complaint investigation under Complaint Control Number: 11-AS-20250812125512. The deficiency was substantiated as the facility was not in compliance with criminal clearance requirements.

The facility was found not in compliance with California Code of Regulations Title 22 due to a staff member lacking the required criminal background clearance and transfer associated with the facility, posing an immediate risk to persons in care.

A Type B deficiency was cited for failure to maintain a separate, complete, and current resident record for each resident, as evidenced by the inability to locate resident R1's file, posing a safety risk to clients in care.

A Type B deficiency was cited for failure to maintain a separate, complete, and current resident record for each resident, as evidenced by the Administrator being unable to locate a resident's file, posing a safety risk to clients in care.

Complaint Control Number 11-AS-20241217143234 was investigated, with findings substantiated related to medication administration and staff certification deficiencies.

The inspection found deficiencies related to medication administration records where medications for some residents were not properly documented as dispensed, and staff certifications for medication administration were not current or available. These deficiencies posed potential health, safety, and personal rights risks to residents.

The visit was complaint-related for Control Number 11-AS-20241217143234. The complaint was investigated through audits, interviews, and observations. Substantiation status is not explicitly stated.

The audit revealed medication administration discrepancies, including medications recorded as dispensed but still in original packaging, and missing Medication Administration Records. Staff certifications for medication administration were incomplete or not current, posing potential health, safety, and personal rights risks to residents. Citations were issued for these deficiencies.

The visit was triggered by a complaint investigation. The complaint involved an incident occurring around December 2024 - January 2025 that the facility failed to report as required. The deficiency was substantiated and cited.

The facility was cited for failing to submit a serious incident report to the licensing agency within the required timeframe, violating California Code of Regulation Title 22 Division 6 Chapter 8.

The visit was complaint-related, triggered by a complaint investigation (Control 11-AS-20250401131451). The complaint involved an incident that occurred around December 2024 - January 2025, which the facility failed to report as required.

The facility was cited for failing to submit a serious incident report as required under California Code of Regulation Title 22 Division 6 Chapter 8. The deficiency involves failure to report an incident involving residents #6 and #7.

The complaint alleged staff mismanaged Resident #1's medication, including unauthorized medication administration, failure to monitor blood glucose levels, and medication refill errors. The complaint also included allegations of failure to safeguard personal items, inadequate dental hygiene, and inadequate feeding. The medication mismanagement allegation was substantiated, while the others were unsubstantiated due to insufficient evidence.

The investigation substantiated the allegation of neglect and lack of care related to medication management, including failure to administer necessary diabetic medications and lack of blood glucose monitoring. Other allegations regarding safeguarding personal items, dental hygiene, and adequate feeding were found unsubstantiated due to insufficient evidence. Significant deficiencies in record-keeping, including missing Medication Administration Records from 2020 through 2024, were identified.

The complaint alleged that staff do not report incidents to residents' responsible parties. The investigation included interviews with residents, staff, and responsible parties, as well as document reviews. The allegation was found unsubstantiated due to lack of preponderance of evidence.

The investigation found the allegation that staff do not report incidents to residents' responsible parties to be unsubstantiated. However, the allegations that staff do not administer medications as prescribed and that staff are not properly trained were substantiated based on interviews, record reviews, and medication administration record (MAR) reviews.

The complaint alleged that staff did not dispense residents' medication as prescribed. The allegation was substantiated based on interviews, record reviews, and evidence gathered. Other allegations including inappropriate staff communication, denial of private phone calls, failure to safeguard personal belongings, failure to provide prescribed medical garments, and unclean facility floors were investigated and found to be unsubstantiated.

The investigation substantiated the allegation that staff did not dispense residents' medication as prescribed, with discrepancies found in medication administration records for five residents. Other allegations regarding inappropriate staff behavior, privacy, safeguarding personal belongings, provision of prescribed medical garments, and cleanliness of the facility were found to be unsubstantiated.

The complaint was substantiated based on the preponderance of evidence standard. The allegation was that staff did not post notice for residents council meetings, which was confirmed by interviews and record reviews.

The investigation found that the facility did not have a Resident Council in place and staff did not post notices for Resident Council meetings. Six out of seven staff interviewed confirmed notices were not posted, and six residents interviewed were unaware of any Resident Council. The allegation was substantiated.

The facility was found to have multiple deficiencies including staff lacking CPR/First Aid certification, incomplete health screenings with TB test results, medication administration record discrepancies, and missing Needs and Services Plans for residents. The physical plant and safety equipment were generally compliant, but several regulatory requirements were not met.

The complaint was substantiated. The allegation was that staff did not report incidents to Community Care Licensing, specifically the failure to submit incident reports for the death of R1. Interviews confirmed that a previously employed staff member responsible for submitting reports did not complete the required report. The current staff member responsible for submitting incident reports confirmed this failure.

The investigation substantiated the allegation that the facility failed to submit the required incident report related to the death of R1. The facility did not have proof that the certified confirmation form was faxed to Community Care Licensing, posing a potential health, safety, or personal rights risk to residents.

Complaint involved allegations that staff did not notify authorized representative of incident, resident sustained injury while in care, staff did not provide a safe environment, staff left resident in soiled clothing/bedding, and staff did not ensure resident's hygiene needs were met. Only the failure to notify authorized representative was substantiated.

The investigation substantiated the allegation that staff did not notify the authorized representative of an incident involving resident #1. Other allegations including resident injury, unsafe environment, and neglect of hygiene needs were found to be unsubstantiated due to insufficient evidence.

The complaint was substantiated based on interviews with staff and residents, document review, and observation of missing personal belongings and equipment. The allegation involved failure to safeguard a resident's personal belongings during a unit transfer.

The investigation substantiated the allegation that facility staff failed to safeguard a resident's personal belongings, including medical equipment and personal items, posing a potential personal rights risk. Deficiencies were cited and a plan of correction was developed with the facility administrator.

The complaint alleged that staff violated residents' personal rights by moving residents between units without notifying residents or their families, causing confusion and upset. It also alleged that staff did not provide a safe and comfortable environment due to construction-related overcrowding, loud noises, chemical smells, and lack of caregiver availability. Both allegations were substantiated based on interviews with staff, witnesses, and residents, and review of records.

The investigation substantiated that staff violated residents' personal rights by relocating residents without notifying them or their families, causing confusion and distress. Additionally, staff failed to provide a safe and comfortable environment during construction and relocation, resulting in overcrowding, exposure to loud noises, chemical smells, and emotional distress among residents.

The complaint investigation was substantiated. Allegations included staff not administering medications as prescribed and mismanaging medications, including a resident missing Memantine medication for a week due to delayed refills. Interviews, record reviews, and audits confirmed these issues.

The investigation substantiated that staff failed to administer medications as prescribed, leading to residents missing vital medications and experiencing adverse effects. Staff admitted to delays in medication refills causing residents to go days without medication. Deficiencies were cited related to medication administration and medical care plans.

The complaint was substantiated based on interviews with staff and residents, file reviews, and observations. The resident R1 was admitted on March 12, 2024, with a prohibited health condition. The facility also allowed a non-resident client to use the facility as a daycare and participate in meals and activities, which is beyond the licensed conditions.

The investigation substantiated both allegations: a resident (R1) was admitted with a prohibited communicable health condition, and the facility allowed a non-resident client (C1) to participate in activities and meals, effectively operating beyond licensed conditions. Two deficiencies were cited related to these findings.