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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331880566
Report Date: 01/27/2022
Date Signed: 01/27/2022 02:06:26 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
01/20/2022 and conducted by Evaluator David Cuevas
COMPLAINT CONTROL NUMBER: 18-AS-20220120081209
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: 5DATE:
01/27/2022
UNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Licensee, Montano RecintoTIME COMPLETED:
02:15 PM
ALLEGATION(S):
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Staff are administering medication to resident without a prescription.
INVESTIGATION FINDINGS:
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On 1/27/22 Licensing Program Analysts (LPA) David Cuevas and Licensing Program Manager (LPM) Deborah Mullen arrived at the residence to investigate allegation above. Upon arrival, LPAs met with Licensee, Montano Recinto and explained the purpose of the visit, who allowed entry.

LPA's condcuted resident record review and identify that medication prescription for Resident's #1,#2,#3,#4,and #5 did not have required medication prescription on file. Based on provided evidence allegation will be SUBSTANTIATED. A substantiated finding means that the allegation is valid because the preponderance of evidence standard has been met.

An exit interview was conducted with Licensee, Montano Recinto were this report, LIC 9099D, and appeal rights were reviewed with and provided to Mr. Recinto.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Joel EsquivelTELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: David CuevasTELEPHONE: (951) 295-3927
LICENSING EVALUATOR SIGNATURE:

DATE: 01/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/27/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 18-AS-20220120081209
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: 01/27/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/31/2022
Section Cited
CCR
87465(h)(6)
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Incidential Medical and Dental Care: (h) The following requirements shall apply to medications which are centrally stored: (6) The licensee shall be responsible for assuring that a record of centrally stored prescription medications for each resident is maintained for at least one year and includes...This requirement was not met evidence by:
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Licensee, will obtain a written prescription for all residents and provide proof by due date 1/31/22
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During a review of residents file no record of centrally stored resident prescriptions were observed for resident #1, 2, 3,4,&5.This poses an immediate health and safety risk to residents in care.
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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 EsquivelTELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: David CuevasTELEPHONE: (951) 295-3927
LICENSING EVALUATOR SIGNATURE:

DATE: 01/27/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/27/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2