331880566-6-7-2023-18-AS-JESL-CT2UTS-20230622155226

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331880566
Report Date: 06/07/2023
Date Signed: 06/07/2023 04:22:51 PM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

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

This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/06/2023 and conducted by Evaluator Janira Arreola

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20230306162606

FACILITY NAME:	FIRST CHOICE SENIOR LIVING		FACILITY NUMBER:	331880566
ADMINISTRATOR:	RECINTO, MONTANO O		FACILITY TYPE:	740
ADDRESS:	34796 MYOPORUM LN		TELEPHONE:	(951) 599-4305
CITY:	MURRIETA	STATE: CA	ZIP CODE:	92563
CAPACITY:	6	CENSUS: 6	DATE:	06/07/2023
		UNANNOUNCED	TIME BEGAN:	02:33 PM
MET WITH:	Staff, Dionisia Malang		TIME COMPLETED:	04:35 PM

ALLEGATION(S):

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Staff are not being trained.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Janira Arreola, conducted an unannounced visit to the facility in order to deliver findings on the above allegation. LPA met with staff, Dionisa Malang who was informed of the purpose of the visit.
During the course of the investigation, the LPA conducted interviews, documented observations, and conducted records reviews.

It was alleged that staff at the facility are not being trained. LPA reviewed the facility file and found that the facility currently has a hospice waiver and dementia care plan in the facility’s program plan. According to Section 87633(b)(6)(A) Hospice Care of Terminally Ill Residents, the staff should be receiving training on needs for hospice patients, turning and incontinence care. LPA reviewed the staff training provided and found that the staff do not have documented training in these topics. LPA reviewed the training for Staff #1 (S1), Staff #2 (S2) and Staff #3 (S3) and found that staff only have training on medication administration and Hoyer lift from a hospice agency.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Joel Esquivel	TELEPHONE: (951) 202-5067
LICENSING EVALUATOR NAME: Janira Arreola	TELEPHONE: 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.

LIC9099 (FAS) - (06/04)

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Control Number 18-AS-20230306162606

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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
	VISIT DATE: 06/07/2023

NARRATIVE

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LPA reviewed the facility’s dementia care plan and found that staff training is planned to be provided to “Caregivers…to assist in activities and to be aware of the special needs of the resident with dementia.” LPA reviewed the training for S1, S2 and S3 and found that there is no dementia care training for these staff on file.

Per the Welfare and Institutions Code (WIC) and reviewed the requirements for training staff. WIC section 15655, employees of residential care facilities for the elderly must have training on mandated reporting. LPA interviewed the Licensee and inquired about staff receiving this training. The licensee stated that none of the staff had not received a mandated reporter training.

Per California Code of Regulations Title 22 section 87411(c)(3)(C) Personnel Requirements- General, all staff are to receive training annually on resident personal rights. LPA interviewed the licensee who asked LPA if this training was a requirement and stated that none of their staff had received this training. Section 87411 states training can be conducted “on-the job”, and documentation of this should be kept in the staff’s file. S1 and S2 were interviewed and stated that S3 had provided on-the-job training in resident ADL’s (activities of daily living), however no documented training was found for these in staff files for S1 and S2.

Based on the information provided, the LPA found that the facility was lacking mandated reporter training, care for individuals with dementia, and personal rights training. Therefore, the allegation was found to be substantiated. A finding that is substantiated means that the preponderance of the evidence standard has been met.

The facility will receive deficiencies for missing staff trainings. These deficiencies were documented as Type B deficiencies, and plans of correction were made with the licensee.

An exit interview was conducted where this report along with LIC809-D pages, and appeal rights were given to staff, Dionisa Malang.

SUPERVISOR'S NAME: Joel Esquivel	TELEPHONE: (951) 202-5067
LICENSING EVALUATOR NAME: Janira Arreola	TELEPHONE: 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

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 18-AS-20230306162606

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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 B 06/30/2023 Section Cited CCR 87405(h)(4)	1 2 3 4 5 6 7	87405 Administrator - Qualifications and Duties (h) The administrator shall have the responsibility to: (4) Recruit, employ and train qualified staff…This requirment was not met as evidenced by: Based on administrator interview and personnel records review, it was found that	1 2 3 4 5 6 7	The administrator agreed to send a self certified statement that they have read and understood the regulation section cited, as well as the regulation pertaining to required staff training. The administrator agreed to send the LPA the required training for all staff including themselves by the POC due date.
	8 9 10 11 12 13 14	staff have not receive the required training. It was found that administrator was unaware of the requirments for staff training. This is a potential personal right, health or saftey risk to the residents in care.	8 9 10 11 12 13 14
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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: Joel Esquivel	TELEPHONE: (951) 202-5067
LICENSING EVALUATOR NAME: Janira Arreola	TELEPHONE: 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

LIC9099 (FAS) - (06/04)

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