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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005809
Report Date: 11/30/2021
Date Signed: 12/01/2021 10:02:07 AM

Document Has Been Signed on 12/01/2021 10:02 AM - 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, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:BRITTA CAREFACILITY NUMBER:
306005809
ADMINISTRATOR:MANGISI, FRANKFACILITY TYPE:
740
ADDRESS:106 S JEANINE WAYTELEPHONE:
(714) 630-4791
CITY:ANAHEIMSTATE: CAZIP CODE:
92806
CAPACITY: 6CENSUS: 6DATE:
11/30/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Norkisa BaladecTIME COMPLETED:
02:30 PM
NARRATIVE
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Licensing Program Analyst (LPA) Lydia Martinez made an unannounced visit to the facility for the purpose of conducting a Required - 1 Year Annual inspection, with an emphasis on Infection Control due to the COVID-19 pandemic. LPA Martinez met and was granted entry by Staff Soledad Larcia. Staff Larcia confirmed there are currently no cases or exposures of COVID-19 within the facility.

LPA observed the "No Visitors" Department posting on COVID-19 precautions at the front door and one posting on refrigerator. There is no sign-in procedure in place, only hand sanitizer for use. LPA observed that both staff were wearing face masks. The facility has an approved Mitigation Plan on file with CCLD. There were 6 residents present during this visit, 2 receiving Hospice Services. LPA conducted a tour of the facility and made observations pertaining to the facility's Infection Control measures. LPA toured all resident rooms, all rooms were within regulations. LPA noted medication in Resident 1 (R1) room. Restroom observed contained soap, toilet paper, but no paper towels, and no hand washing signs posted. Facility has operating smoke and carbon monoxide detectors. Facility has Fire Extinguishers which was last charged on 03/04/2021. The facility was equipped with sufficient hand hygiene supplies, cleaning and disinfecting provisions. Personal Protective Equipment (PPE) supply is available. The facility monitors the residents regularly for any COVID-19 symptoms/change of condition. Facility has required Emergency Disaster Plan posted, and a secured location for resident's medication and files. Facility has 30 days supply of medications for the residents. Residents emergency contact information and Physicians reports are current. LPA reviewed resident files.

Based on the observations made during the visit, the following deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. This report, along with Appeals Rights, Confidential Names (Lic811), LIC9102 TA) was discussed with the Administrator and copies will be emailed.
SUPERVISORS NAME: Marina Stanic
LICENSING EVALUATOR NAME: Lydia Martinez
LICENSING EVALUATOR SIGNATURE: DATE: 11/30/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/30/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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Document Has Been Signed on 12/01/2021 10:02 AM - It Cannot Be Edited


Created By: Lydia Martinez On 11/30/2021 at 12:50 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: BRITTA CARE
FACILITY NUMBER: 306005809

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/30/2021

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
87468.1(a)(2)
(a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above. Facility does not have COVID precaution/policy posted at facility entrance or throughout facility. LPA was not screened at entrance, no sign in policy in place, visitors are not screened, no papertowels in bathrooms, and no hand washing guidelines posted in bathrooms. This poses a potential health and personal rights risk to persons in care.
POC Due Date: 12/03/2021
Plan of Correction
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Administrator to post and follow COVID precaution/policy signage/screening at entrance to facility and throughout facility and forward proof to LPA by POC due date.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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.
SUPERVISOR'S NAME:Marina Stanic
LICENSING EVALUATOR NAME:Lydia Martinez
LICENSING EVALUATOR SIGNATURE:
DATE: 11/30/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/30/2021


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Document Has Been Signed on 12/01/2021 10:02 AM - It Cannot Be Edited


Created By: Lydia Martinez On 11/30/2021 at 12:14 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: BRITTA CARE
FACILITY NUMBER: 306005809

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/30/2021

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
87608(a)(5)(B)


This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA's observation, the Administrator did not comply with the section cited above in that LPA Martinez observed full bedrails on bed of R1. Staff report R1 is not on hospice. This poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 12/02/2021
Plan of Correction
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Licensee to remove full bedrail and obtain physician order for half rails if need for R1 and submit proof of correction by 12/02/2021.
Type A
Section Cited
CCR
87465(h)(2)


This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above. LPA observed unsecured medications (2 bottles of Mucus Relief Chest and an Inhaler in R1's room.This poses an immediate health and safety risk to persons in care.
POC Due Date: 12/01/2021
Plan of Correction
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Staff removed medication from room and locked away. Administrator to conduct in-service training on section cited and submit proof to CCLD by close of business day of 12/10/2021
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Marina Stanic
LICENSING EVALUATOR NAME:Lydia Martinez
LICENSING EVALUATOR SIGNATURE:
DATE: 11/30/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/30/2021


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Document Has Been Signed on 12/01/2021 10:02 AM - It Cannot Be Edited


Created By: Lydia Martinez On 11/30/2021 at 01:10 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: BRITTA CARE
FACILITY NUMBER: 306005809

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/30/2021

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
87618(b)(3)(B)
Oxygen Administration, "No Smoking-Oxygen in Use" signs shall be posted in the appropriate areas. This requirement is not being met as evidenced by:

This requirement is not met as evidenced by:
Deficient Practice Statement
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During the visit, LPA observed R2 and R3 have Oxygen machines present in their room and there are no "Oxygen in Use" signs present on their door. This poses a potential risk to the health and safety of the residents in care.
POC Due Date: 12/02/2021
Plan of Correction
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Administrator to post an "Oxygen in Use" sign on the door of R2 and R3 and to train all staff on section cited. Proof of correction to be sent to LPA by POC due date.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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.
SUPERVISOR'S NAME:Marina Stanic
LICENSING EVALUATOR NAME:Lydia Martinez
LICENSING EVALUATOR SIGNATURE:
DATE: 11/30/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/30/2021


LIC809 (FAS) - (06/04)
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