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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331880566
Report Date: 06/27/2022
Date Signed: 06/27/2022 11:03:36 AM


Document Has Been Signed on 06/27/2022 11:03 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
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: 4DATE:
06/27/2022
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
09:55 AM
MET WITH:Licensee- Montano RecintoTIME COMPLETED:
11:10 AM
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On 6/27/22 Licensing Program Analyst (LPA) Janira Arreola made an unannounced visit at the facility for the purpose of conducting a health and safety check. LPA Arreola met with Licensee Montano Recinto, and explained the purpose of the visit.

At the time of the visit there was (3) staff and (4) residents present. LPA conducted a tour of the facility's interior and exterior. R1 was observed watching TV in the dinning room. R2, R3, and R4 were observed in their respective rooms.

LPA observed the facility's food supply which met the requirements; 2 day supply of perishable and a 7 day supply of non-perishable food items. LPA observed a 30 day supply for resident's medications, and enough paper supply. LA observed a sufficient 30 day supply of PPE at the facility.

No citations were issued t the time of the vistit concerning health and safety. An exit interview was conducted, and a copy of this report was provided to Licensee, Montano Recinto.
SUPERVISOR'S NAME: Joel EsquivelTELEPHONE: (951) 202-5067
LICENSING EVALUATOR NAME: Janira ArreolaTELEPHONE: 951-248-2222
LICENSING EVALUATOR SIGNATURE:
DATE: 06/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/27/2022
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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