331880566-5-4-2022-18-AS-JESL-CETVWS-20220527164824

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331880566
Report Date: 05/04/2022
Date Signed: 05/04/2022 02:27:06 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
04/28/2022 and conducted by Evaluator Javina George

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20220428125557

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: 2	DATE:	05/04/2022
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Montano Recinto, Administrator		TIME COMPLETED:	02:35 PM

ALLEGATION(S):

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Facility utilizing closet as sleeping quarters for staff.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Javina George made an unannounced visit to the facility to commence a complaint investigation for the allegation listed above. LPA was greeted and granted entry by Caregiver Maria Basubas and explained the purpose of the visit. The administrator Montano arrived shortly after. At the time of the visit there were (2) staff and (2) residents present.

The investigation investigation consisted of a tour of the interior and exterior of the facility, reviewed resident files and conducted staff interviews. During the tour of the facility LPA observed in the hallway closet there to be a dresser full with Staff #1 belongings, suitcases, rollaway bed pillows, hoyer lift folded blankets and shoes. Inside of what is indicated on the facility sketch to be the pantry, LPA observed another dresser with Staff #2 belongings (scrubs, pajamas, hygiene items). Additionally, in the pantry LPA observed, a smoke detector as well as a vent that was reported to have been recently installed. LPA conducted interviews with staff that admitted that they were live in caregivers, but were sleeping on the couch. *** Continued on 9099C.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Joel Esquivel	TELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Javina George	TELEPHONE: (951) 204-7107
LICENSING EVALUATOR SIGNATURE:	DATE: 05/04/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2022

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-20220428125557

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: 05/04/2022

NARRATIVE

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During an interview with the Administrator Montano, he admitted that he his staff do in fact sleep in the closet. LPA pointed out that there are two vacant rooms that could be utilized for staff sleeping quarters. Montano stated that there were recent death, that it was viewed as scary to the staff.

Based on observation, interview record review the allegation of Facility utilizing closet as sleeping quarters for staff is SUBSTANTIATED. A finding that the complaint is SUBSTANTIATED means that the allegation is valid because the preponderance of the evidence standard has been met.

An exit interview was conducted and a copy of this report, 9099D, LIC811, and appeal rights were provided.

SUPERVISOR'S NAME: Joel Esquivel	TELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Javina George	TELEPHONE: (951) 204-7107
LICENSING EVALUATOR SIGNATURE:	DATE: 05/04/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2022

LIC9099 (FAS) - (06/04)

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Control Number 18-AS-20220428125557

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: 05/04/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Request Denied Type A 05/05/2022 Section Cited CCR 87307(a)(C)	1 2 3 4 5 6 7	87307 Personal Accommodations and Services (a) Living accommodations and grounds shall be related to the facility's function. The facility shall be large enough to provide comfortable living accommodations and privacy for the residents, staff, and others who may reside in the facility. The following provisions shall apply: (C) No bedroom of a resident shall be used as a passageway to another room, bath or toilet. This requirement is not met as evidenced by: the master closet being made into a room for staff, and the pantry being a passage way leading to bedroom # 3. This poses an immediate health and safety risks to persons in care.	1 2 3 4 5 6 7	The Licensee agreed to continue the process to obtain the necessary permits, AND to have to sleep in the 2 vacant bedrooms. (Room #1 and Room #3).
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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) 248-0312
LICENSING EVALUATOR NAME: Javina George	TELEPHONE: (951) 204-7107
LICENSING EVALUATOR SIGNATURE:	DATE: 05/04/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2022

LIC9099 (FAS) - (06/04)

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