Community Care Licensing

Document Has Been Signed on 09/27/2024 10:19 AM - It Cannot Be Edited

FACILITY NAME:	CHOICES R US - MIGUEL		FACILITY NUMBER:	198601716
ADMINISTRATOR/ DIRECTOR:	CARDENAS, GILBERT		FACILITY TYPE:	735
ADDRESS:	3951 MIGUEL AVE		TELEPHONE:	(562) 801-3061
CITY:	PICO RIVERA	STATE: CA	ZIP CODE:	90660
CAPACITY: 4		CENSUS: 3	DATE:	09/27/2024
TYPE OF VISIT:	Case Management - Deficiencies	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	08:22 AM
MET WITH:	Isidro Serrano - DSP		TIME VISIT/ INSPECTION COMPLETED:	10:35 AM

SUPERVISORS NAME: David Sicairos LICENSING EVALUATOR NAME: Erik Zaragoza LICENSING EVALUATOR SIGNATURE: DATE: 09/27/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/27/2024

Link to Parent Document Below:

FACILITY NAME: CHOICES R US - MIGUEL	FACILITY NUMBER: 198601716
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/27/2024

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 09/28/2024 Section Cited CCR 80072(a)(3)	1 2 3 4 5 6 7	(a) Except for children’s residential facilities, each client shall have personal rights which include, but are not limited to, the following: (3) To be free from corporal or unusual punishment, infliction of pain (...) including but not limited to: interference with the daily living functions (...) or aids to physical functioning.	1 2 3 4 5 6 7	Administrator is to ensure that all clients will remain free from corporal and unusual punishment, including the inflection of pain at all times. Administrator is to submit to LPA the facility's written plan on how the staff will ensure that no other client is sustains a serious bodily injury and is free from (...)
	8 9 10 11 12 13 14	This regulation is not met as evidenced by: Based on interview and record review, LPA determined that C1 was not free from the infliction of pain as a result of a fractured right clavicle they sustained in an interaction with S4, which posed an immediate health and safety threat to clients in care.	8 9 10 11 12 13 14	the infliciton of pain to the LPA by the POC due date.
Type A 09/28/2024 Section Cited CCR85165(a)	1 2 3 4 5 6 7	(a) The licensee shall ensure staff who use, participate in, approve. or provide visual checks of manual restraint or seclusion only use techniques specified in the Emergency Intervention Plan and which are not prohibited in Section 85102. This regulation is not met as evidenced by:	1 2 3 4 5 6 7	Administrator is to ensure that proper CPI and other emergnecy intervention procedures are followed at all times. Administrator is to conduct a retraining on proper emergency intervention techniques to address instances in which clients may become aggressive, and submit to LPA a list of the attendees (...)
	8 9 10 11 12 13 14	Based on interview and record review, LPA determined that a proper CPI hold was not utilized during an incident in which C1 displayed aggressive behavior, and led to their serious bodily injury, which posed an immediate health and safety risk to clients in care.	8 9 10 11 12 13 14	along with training materials, and topics covered in the training by the POC due date.

SUPERVISOR'S NAME: David Sicairos LICENSING EVALUATOR NAME: Erik Zaragoza LICENSING EVALUATOR SIGNATURE: DATE: 09/27/2024

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/27/2024