331880566-1-17-2025-18-AS-AZEO-DD22FC-20250117162119

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 331880566
Report Date: 01/17/2025
Date Signed: 01/17/2025 04:21:25 PM

Document Has Been Signed on 01/17/2025 04:21 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
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME:	FIRST CHOICE SENIOR LIVING		FACILITY NUMBER:	331880566
ADMINISTRATOR/ DIRECTOR:	RECINTO, MONTANO O		FACILITY TYPE:	740
ADDRESS:	34796 MYOPORUM LN		TELEPHONE:	(951) 599-4305
CITY:	MURRIETA	STATE: CA	ZIP CODE:	92563
CAPACITY: 6	TOTAL ENROLLED CHILDREN: 0	CENSUS: 2	DATE:	01/17/2025
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	02:30 PM
MET WITH:	Donisia Malang		TIME VISIT/ INSPECTION COMPLETED:	04:30 PM

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Licensing Program Analysts (LPAs) Abdoulaye Zerbo and Venus Mixson conducted an unannounced visit for a required annual inspection. The LPAs were greeted by Caregiver Donisia Malang, notified her of the purpose for the visit and were allowed to enter the facility to conduct the inspection.

Facility Overview: The facility is a single story building with five (5) residents bedrooms, four(4) bathrooms, a living room and a kitchen area. There is no gated pool and there are no firearms on the premises.

Infection Control: LPAs observed that hygiene and cleaning supplies were available for regular facility maintenance. The facility’s infection control plan was reviewed and found to meet department requirements.

Physical Plant: The physical plant, including floors, windows, and doors, was clean and well maintained. Fixtures and furniture were in good repair. Laundry equipment was in good working condition. Sharp and dangerous objects were securely locked in the kitchen inaccessible to residents. The smoke detector and carbon monoxide detector were operational. LPAs observed fire extinguishers to be in compliance with the department requirements and with an expiration date of September 27, 2025. The water temperature was tested within regulations.

Continued 809-C......

Rikesha Stamps	TELEPHONE: (951) 212-0616
Abdoulaye Zerbo	TELEPHONE: (951) 248-2222
	DATE: 01/17/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/17/2025

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

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

FACILITY NAME: FIRST CHOICE SENIOR LIVING	FACILITY NUMBER: 331880566
	VISIT DATE: 01/17/2025

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Care & Supervision/Administration: Adequate staff were present to supervise clients during the visit. The administrator holds a current administrator’s certificate with expiration date of September 27, 2025.

Record Review and Resident/Staff Files: LPAs reviewed files for two(2) staff members, confirming criminal clearances, updated training, and CPR/First Aid certification. Two (2) residents' files were reviewed and contained all required documentation. LPAs observed first aid kit to be stored in the kitchen area. The residents and staff files were kept in a locked cabinet in the living room inaccessible to unauthorized individuals. A technical violation was cited because the Administrator did not have personal file at the facility.

Health-Related Services/Incidental Medical Services: All residents' medications were securely locked in a cabinet and located in the kitchen area. LPAs reviewed medications for two residents, confirming that all medications were listed and accounted for.

An exit interview was conducted, during which this report was reviewed, and a copy was provided to administrator Recinto Montano.

SUPERVISOR'S NAME: Rikesha Stamps	TELEPHONE: (951) 212-0616
LICENSING EVALUATOR NAME: Abdoulaye Zerbo	TELEPHONE: (951) 248-2222
LICENSING EVALUATOR SIGNATURE:	DATE: 01/17/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/17/2025

LIC809 (FAS) - (06/04)

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