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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198601716
Report Date: 10/17/2024
Date Signed: 10/17/2024 11:21:39 AM

Document Has Been Signed on 10/17/2024 11:21 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
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:CHOICES R US - MIGUELFACILITY NUMBER:
198601716
ADMINISTRATOR/
DIRECTOR:		CARDENAS, GILBERTFACILITY TYPE:
735
ADDRESS:3951 MIGUEL AVETELEPHONE:
(562) 801-3061
CITY:PICO RIVERASTATE: CAZIP CODE:
90660
CAPACITY: 4CENSUS: 3DATE:
10/17/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:52 AM
MET WITH:Isidro Serrano - DSP TIME VISIT/
INSPECTION COMPLETED:
11:36 AM
NARRATIVE
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Licensing Program Analyst (LPA) Erik Zaragoza conducted a case management visit in response to a Semi-Annual Residential Review report received from the East Los Angeles Regional Center (ELARC). LPA met with Isidro Serrano, Direct Support Staff (DSP) for the facility, and explained the purpose of the visit.

In the report received from ELARC, there were regulations noted to be not met by the facility, including that expired food had been found within the facility, and that there were medication errors present in the month of September 2024 as well. During the visit LPA checked the non-perishable food supply and found that there were one canned food product that had past its expiration date. Additionally during review of the client medications, found that there was missing mediation for C1 that was signed off as having been administered in the Medication Administration Records (MARs). LPA asked staff if the medication was present within the facility, and it was determined that the medication had been discontinued based on documentation that had been received from the client's physician. LPA also conducted a tour of the facility including checking the hot water temperature of the facility which measured at 105.8 Degrees Fahrenheit. The facility was observed to be clean and in good repair. No additional health or safety concerns were noted.

Per California Code of Regulations, Title 22, Division 6, Chapter 1, the deficiencies observed during the visit is documented on the LIC809D pages. Exit interview held and a copy of the report along with appeal rights were provided.
SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Erik Zaragoza
LICENSING EVALUATOR SIGNATURE: DATE: 10/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/17/2024
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 10/17/2024 11:21 AM - It Cannot Be Edited


Created By: Erik Zaragoza On 10/17/2024 at 10:45 AM
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
, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: CHOICES R US - MIGUEL
FACILITY NUMBER: 198601716

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/17/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/04/2024
Section Cited
CCR
80076(a)(1)

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(a) In facilities providing meals to clients, the following shall apply: (1) All food shall be safe and of the quality and in the quantity necessary to meet the needs of the clients(...)
All food shall be selected, stored, prepared and served in a safe and healthful manner.
This regulation is not met as evidence by:
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Administrator is to ensure that all canned food are within their expiration date at all times. Administrator is to remove the can from the pantry and also submit a written plan to LPA on how the facility will ensure that no expired foods will be kept in the facility moving forward by the POC due date.
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Based on observation, there was a single can of food that was still expired and present within the kitchen of the facility, which poses a potential health and safety risk to clients in care.
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Type B
10/24/2024
Section Cited
CCR80075(b)(5)(B)

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(b) Clients shall be assisted (...) with self-administration of prescription and nonprescription medications. (5)If the client's physician has stated in writing that the client is unable to determine (...) (B) Once ordered (...) given according to the physician's directions.
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**POC Cleared** Administrator is to ensure that medication records are kept accurate at all times. Administrator is to submit LPA the discontinue notice for the client's medication by the POC due date.
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This regulation is not met as evidenced by:
Based on record review, C1 had a medication for Vitamin D3 that was being signed off on the MARs, however the medication had been discontinued on 10/1/2024, which poses a potential health and safety risk to clients in care.
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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:David Sicairos
LICENSING EVALUATOR NAME:Erik Zaragoza
LICENSING EVALUATOR SIGNATURE:
DATE: 10/17/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/17/2024


LIC809 (FAS) - (06/04)
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