<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331880733
Report Date: 09/21/2022
Date Signed: 09/21/2022 03:12:38 PM


Document Has Been Signed on 09/21/2022 03:12 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
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507



FACILITY NAME:FIRST CHOICE SENIOR LIVING 2FACILITY NUMBER:
331880733
ADMINISTRATOR:RECINTO, MONTANO OFACILITY TYPE:
740
ADDRESS:40147 GRENACHE CTTELEPHONE:
(951) 239-0132
CITY:MURRIETASTATE: CAZIP CODE:
92563
CAPACITY:6CENSUS: 3DATE:
09/21/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
11:59 AM
MET WITH:Licensee, Montano RecintoTIME COMPLETED:
03:20 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA, Janira Arreola, made an unannounced visit in order to cite deficiencies observed. LPA met with Licensee, Montano Recinto who was informed of the purpose of the visit. At the time of the visit there were (2) staff and (3) residents present.

LPA took a tour of the facility's interior and exterior. LPA walked through the resident bedrooms, the facility has (6) bedrooms, (1) is used as a staff room, (3) are unoccupied and (2) are occupied. LPA noted that the facility has a bedroom that is being used as a passage way to another bedrooms. LPA was informed by staff at 12:25 p.m. that these rooms were private rooms. LPA took pictures of the bedrooms. Both of these private rooms are currently vacant. This poses a risk to residents in care.

LPA was informed by Licensee that the facility would be closing at the end of the month 9/30/2022 and stated that he was relocating his residents. LPA asked Licensee if the residents had been given a 60-day notice to vacate. Licensee sent these documents over to LPA. Eviction notice for Resident #1 (R1) was not sent to Licensee, this poses a risk to the resident.

LPA requested staff files for Staff 1 (S1) and Staff 2 (S2), Licensee was unable to provide these to LPA during the time of the visit. Licensee showed S2's photo copy of ID card, and S1's training on medication management, naso-gastric tube training, and ID card. All other personnel files requested such as training, clearance transfer, first aid training, and application were not available. This poses a risk for residents in care.

LPA was informed by S1 that R1 was bedridden. Licensee also stated that R1 is bedridden. LPA reviewed R1's file and found that R1 was listed as non-ambulatory in March 2022. LPA asked what assessment was made for resident after this date to state that the resident is bedridden. Licensee was unable to provide this documentation to LPA.. This poses a risk for residents in care.

Deficiencies were documented on LIC809-D page along with Plan of correction.

An exit interview was conducted where this report along with appeal rights and LIC809-D pages were reviewed and 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: 09/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/21/2022
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 4


Document Has Been Signed on 09/21/2022 03:12 PM - It Cannot Be Edited

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 2
FACILITY NUMBER: 331880733

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/21/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/30/2022
Section Cited

1
2
3
4
5
6
7
"87412 Personnel Records (a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee..." This requirment was not met as evidenced by:
8
9
10
11
12
13
14
LPA requested staff file for S1 and S2. LPA received incomplete files from Licensee. LPA was only able to review ID card, and (2) copies of staff training. This poses a potential saftey, health or personal rights risk to residents in care.
8
9
10
11
12
13
14
Type B
09/30/2022
Section Cited

1
2
3
4
5
6
7
"87506 Resident Records (d) All resident records shall be available to the licensing agency to inspect, audit, and copy upon demand during normal business hours..." This requirment was not met as evidenced by:
8
9
10
11
12
13
14
LPA requested resident records for R1 for changing ambulatory status. Licensee was unable to provide these documents to LPA at the time of the visit. LPA reviewed R1's file and was unable to find the updated ambulatory status since March 2022. This poses a potential personal rights, health or saftey risk to residents in care.
8
9
10
11
12
13
14
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) 202-5067
LICENSING EVALUATOR NAME: Janira ArreolaTELEPHONE: 951-248-2222
LICENSING EVALUATOR SIGNATURE:
DATE: 09/21/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/21/2022
LIC809 (FAS) - (06/04)
Page: 2 of 4


Document Has Been Signed on 09/21/2022 03:12 PM - It Cannot Be Edited

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 2
FACILITY NUMBER: 331880733

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/21/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/30/2022
Section Cited

1
2
3
4
5
6
7
"87307 Personal Accommodations and Services (a) Living accommodations and grounds... The following provisions shall apply: (1) There shall be... (2) Resident bedrooms... which meet, at a minimum, the following requirements: (C) No bedroom of a resident shall be used as a passageway to another room..."
8
9
10
11
12
13
14
This requirment was not met as evidence by: LPA found (2) private rooms connected by a door. (1) room was a passage way to the other. LPA asked staff who stated that both rooms were private rooms. This poses a potential personal rights, health or saftey risk to residents in care.
8
9
10
11
12
13
14

1
2
3
4
5
6
7

1
2
3
4
5
6
7
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) 202-5067
LICENSING EVALUATOR NAME: Janira ArreolaTELEPHONE: 951-248-2222
LICENSING EVALUATOR SIGNATURE:
DATE: 09/21/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/21/2022
LIC809 (FAS) - (06/04)
Page: 3 of 4


Document Has Been Signed on 09/21/2022 03:12 PM - It Cannot Be Edited

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 2
FACILITY NUMBER: 331880733

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/21/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/22/2022
Section Cited

1
2
3
4
5
6
7
"87224 Eviction Procedures
(a) The licensee may evict a resident... (A) ... upon no less than sixty (60) days written notice... due to change of use of the facility. 1. In addition...written notice to evict... shall be made to the resident or the resident’s responsible person..." This requirment was not met as evidenced by:
8
9
10
11
12
13
14
LPA requested Licensee provide proof of a 60-day eviciton notice for R1. Licensee was unable to provide a copy of this notice. This poses an immediate health, saftey, or personal rights risk to R1.
8
9
10
11
12
13
14

1
2
3
4
5
6
7

1
2
3
4
5
6
7
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) 202-5067
LICENSING EVALUATOR NAME: Janira ArreolaTELEPHONE: 951-248-2222
LICENSING EVALUATOR SIGNATURE:
DATE: 09/21/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/21/2022
LIC809 (FAS) - (06/04)
Page: 4 of 4