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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331880566
Report Date: 06/07/2023
Date Signed: 06/07/2023 04:22:07 PM


Document Has Been Signed on 06/07/2023 04:22 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, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507



FACILITY NAME:FIRST CHOICE SENIOR LIVINGFACILITY NUMBER:
331880566
ADMINISTRATOR:RECINTO, MONTANO OFACILITY TYPE:
740
ADDRESS:34796 MYOPORUM LNTELEPHONE:
(951) 599-4305
CITY:MURRIETASTATE: CAZIP CODE:
92563
CAPACITY:6CENSUS: 6DATE:
06/07/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
02:41 PM
MET WITH:Staff, Dionisa MalangTIME COMPLETED:
04:35 PM
NARRATIVE
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Licensing Program Analst (LPA) Janira Arreola conducted an unannounced visit in order to deliver findings for a complaint #18-AS-20230306162606. LPA met with staff, "Daisy" Dionisia Malang and informed them of the purpose of the visit. The LPA called the administrator over the phone, Montano Recinto. During the time of the visit there were (2) staff and (4) residents present.

During the visit LPA found deficiencies unrelated to the complaint allegations. LPA found unlocked medications for staff and residents in the facility fridge. Additionally LPA found the facility has a fridge that is able to be locked that was kept unlocked with more resident medications. This deficiency was cited along with plan of correction. LPA also observed (1) jar of pasta sauce in the facility fridge that had a large black and green spot on the inside of the jar, about 1-inch in diameter. LPA checked the date that stated 12/2023. LPA opened the jar and showed staff a fuzzy green, gray and black spot on the inside. The staff threw the sauce away. The sauce was three-fourths of the way empty. This deficiency was cited as well as plan of correction for this.

An exit interview was conducted with staff Dionisa Malang, where this report along with deficiency pages and appeal rights were reviewed and provided to them.
SUPERVISOR'S NAME: Joel EsquivelTELEPHONE: (951) 202-5067
LICENSING EVALUATOR NAME: Janira ArreolaTELEPHONE: 951-248-2222
LICENSING EVALUATOR SIGNATURE:
DATE: 06/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/07/2023
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 06/07/2023 04:22 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507


FACILITY NAME: FIRST CHOICE SENIOR LIVING
FACILITY NUMBER: 331880566

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/07/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/08/2023
Section Cited
CCR
87555(b)(9)

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(b) The following food service requirements shall apply: (9)Procedures which protect the safety, acceptability and nutritive values of food shall be observed in food storage, preparation and service. This requirment was not met as evidenced by: Based on observation LPA found (1) jar of pasta
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The staff agreed to send the LPA a self certified statement that they would ensure all facility food in a safe and consumable state weekly by the POC due date.
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sauce that had green fuzzy spot inside the jar. The jar jad last been given to the residents The staff threw the jar away immediately. This poses an immediate personal rights, health or saftey risk to residents in car.
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Type A
06/08/2023
Section Cited
CCR87465(h)(2)

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(h) The following requirements shall apply to medications which are centrally stored:
(2) Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees...This requirment was not met as evidenced by:
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The facility staff agreed to send the LPA photos of the medications removed from the facility fridge and placed in the designated locked medication fridge. The staff agreed to send the LPA self certified statements that they would ensure all medication is kept in a locked place inaccesible to residents.
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Based on observation and staff interview, it was found that resident and staff medications are kept unlocked in the facility fridge. The facility has a designated fridge for medications that was found to be unlocked. This is an immediate health, saftey or personal rights risk.
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This shall be sent to the LPA by the POC due date.
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: Joel EsquivelTELEPHONE: (951) 202-5067
LICENSING EVALUATOR NAME: Janira ArreolaTELEPHONE: 951-248-2222
LICENSING EVALUATOR SIGNATURE:
DATE: 06/07/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/07/2023
LIC809 (FAS) - (06/04)
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