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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331880566
Report Date: 01/03/2022
Date Signed: 01/03/2022 03:21:19 PM

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:
01/03/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:10 AM
MET WITH:Montano Recinto, Administrator TIME COMPLETED:
03:35 PM
NARRATIVE
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Licensing Program Analyst (LPA) Yolanda Delgado made an unannounced visit to the facility to conduct an annual inspection with an emphasis on infection control. LPA arrived at 10:10 AM, LPA was met by caregiver Dionisia Malang and explained the purpose of the visit. Present in the facility during time of visit were two (2) staff as well as six (6) residents. Administrator Recinto arrived shortly later. There are currently no cases of COVID-19 within the facility.

During today's visit, LPA toured the facility and made observations pertaining to the facility's infection control measures. LPA observed disinfecting provisions, and proper use of face coverings. The facility has a designated infection control lead person who has been tasked with tracking all COVID-19 cases and/or suspected cases, cleaning and disinfection provisions are in adequate quantities, and that staff are trained in the proper use and disposal of PPE and overall infection control. The facility has a plan in place which follows Community Care Licensing guidelines for when and how long to test staff and residents for COVID-19, when and how to isolate/quarantine residents, and when to schedule cleaning and disinfection times of high traffic and frequently touched areas. The facility also has a plan in place to subsequently notify the resident(s) physician and to notify all emergency agencies in the event of any COVID-19 related and/or suspected illnesses.

Based on the observations made during today’s visit, Deficiencies and civil penalties were cited per Title 22, Division 6, of the California Code or Regulations. An exit interview to review this report was conducted and a copy of this report was provided.
SUPERVISOR'S NAME: Efren MalagonTELEPHONE: (951) 248-0337
LICENSING EVALUATOR NAME: Yolanda DelgadoTELEPHONE: (951) 203-0337
LICENSING EVALUATOR SIGNATURE:

DATE: 01/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/03/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 3
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: 01/03/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
87468.1(a)(6)


This requirement is not met as evidenced by:
Deficient Practice Statement
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 (6) To leave or depart the facility at any time and to not be locked into any room, building, or on facility premises by day or night...This requirement was not being met as evidenced by: During a facility inspection on 1/3/2022, LPA observed the front door to have three locks on the interior of the front door. In addition, LPA observed a keyed deadbolt on resident bedroom #1 and #2. This poses an immediate health and safety risk to residents in care.
POC Due Date: 01/04/2022
Plan of Correction
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Per the licensee, the three locks and keyed deadbolt from resident bedrooms #1 and #2 will be removed immediately and proof of removal submitted today, 1/3/2022.
Type A
Section Cited
CCR
87203


This requirement is not met as evidenced by:
Deficient Practice Statement
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Fire Safety: All facilities shall be maintained in conformity with the regulations adopted by the State Fire Marshal for the protection of life and property against fire and panic...This requirement was not being met as evidenced by: During a facility inspection on 1/3/2022, LPA observed a hall closet and a pantry being used as staff bedrooms. This poses a potential health and safety risk.
POC Due Date: 01/04/2022
Plan of Correction
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Licensee will empty the closet and pantry and discontinue use as living accomodations. Proof of correction will be submitted to licensing by 1/4/2022.
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: Efren MalagonTELEPHONE: (951) 248-0337
LICENSING EVALUATOR NAME: Yolanda DelgadoTELEPHONE: (951) 203-0337
LICENSING EVALUATOR SIGNATURE:
DATE: 01/03/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/03/2022
LIC809 (FAS) - (06/04)
Page: 2 of 3
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: 01/03/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
87468.2(a)


This requirement is not met as evidenced by:
Deficient Practice Statement
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4
(a) In addition, Personal Rights of Residents in All Facilities...this requirement is not met as evidenced by licensee did not ensure sufficent PPE, COVID-19 screening protocols and practices for all staff, residents and visitors the personal rights of persons in care to safe and healthful to the health, welfare, and safety of persons in care, as required by the CA Dept. of Public Health Guidance.
POC Due Date: 01/04/2022
Plan of Correction
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The licensee will obtain PPE supplies, update screening protocols and practice. Proof of correction will be submitted to licensing by 1/4/2022
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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: Efren MalagonTELEPHONE: (951) 248-0337
LICENSING EVALUATOR NAME: Yolanda DelgadoTELEPHONE: (951) 203-0337
LICENSING EVALUATOR SIGNATURE:
DATE: 01/03/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/03/2022
LIC809 (FAS) - (06/04)
Page: 3 of 3