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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331880733
Report Date: 09/11/2023
Date Signed: 09/11/2023 11:13:27 AM

Unsubstantiated


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
02/11/2020 and conducted by Evaluator Javina George
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20200211110720
FACILITY NAME:FIRST CHOICE SENIOR LIVING 2FACILITY NUMBER:
331880733
ADMINISTRATOR:RECINTO, MONTANO OFACILITY TYPE:
740
ADDRESS:40147 GRENACHE CTTELEPHONE:
(570) 971-0448
CITY:MURRIETASTATE: CAZIP CODE:
92563
CAPACITY:0CENSUS: 0DATE:
09/11/2023
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Montano Recinto, Licensee TIME COMPLETED:
12:00 PM
ALLEGATION(S):
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Facility failed to meet the resident’s needs causing resident to sustain multiple fractures while in care.
INVESTIGATION FINDINGS:
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On 9/11/2023 Licensing Program Analyst (LPA) Javina George delivered findings for the allegation noted above. LPA met virtually with Licensee Montano Recinto, and explained the purpose of the visit and the elements of the allegation.

The department investigated the allegation of " Facility failed to meet the resident’s needs; causing resident to sustain multiple fractures while in care." The investigation consisted of interviews with staff, residents, and other pertinent individuals such as R1’s responsible party and medical personnel. A review of facility documents and medical records for Resident #1 (R1) was conducted. Medical records with admit date of 02/08/2020 indicated R1 sustained bilateral distal femur fractures in both legs.

R1 experienced two separate falls, occurring on 02/07/2020 and 02/08/2020. R1 requires a two-person assist per R1’s appraisal/needs and services plan dated 11/26/2015. The plan revealed that R1 is unable to stand, transfer, stand or walk without extensive assistance. *** Continued on 9099C
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Joel EsquivelTELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Javina GeorgeTELEPHONE: (951) 204-7107
LICENSING EVALUATOR SIGNATURE:

DATE: 09/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2023
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 3
Control Number 18-AS-20200211110720
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 2
FACILITY NUMBER: 331880733
VISIT DATE: 09/11/2023
NARRATIVE
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American Medical Response (AMR) reported dated 02/08/2020, revealed that facility staff reported to emergency medical response personnel, that on 02/07/2020 R1 was attempting to stand and fell into their wheelchair. Staff interviews revealed only one staff was assisting R1 to stand and fell into their wheelchair. Staff #1 (S1) admitted to being the only staff that provided assistance to R1 when R1 fell. Facility staff reported they did not notice any injuries from this fall. Interviews also revealed R1 did not complain of pain.

Staff interviews revealed that R1 sustained a second fall on 02/08/2020. At the time of this fall, two staff were assisting R1 with toileting. When R1 fell, R1 complained of leg pain and staff called 911.

Per the interview with the medical professional, when R1 fell into their wheelchair on 02/07/2020 it “is plausible explanation caused the fracture; however, this type of injury is typically caused by a fall. Due to R1s age and depending on the extent of their Osteoporosis this injury could have been caused by a simple “misstep.” It is unclear if the injury/fracture was from the fall that occurred on 02/07/2020 or on 02/08/2020. Because there is not a clear determination of when R1 sustained the fractures to both legs, either when R1 was being assisted by two staff or when they were being assisted by one staff, the allegation of facility failed to meet the resident’s needs causing resident to sustain multiple fractures while in care" is UNSUBSTANTIATED at this time. A finding that the complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation(s) occurred.


An exit interview was conducted and a copy of this report was reviewed and provided to Montano Recinto, Licensee.
SUPERVISOR'S NAME: Joel EsquivelTELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Javina GeorgeTELEPHONE: (951) 204-7107
LICENSING EVALUATOR SIGNATURE:

DATE: 09/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 3
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
02/11/2020 and conducted by Evaluator Javina George
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20200211110720

FACILITY NAME:FIRST CHOICE SENIOR LIVING 2FACILITY NUMBER:
331880733
ADMINISTRATOR:RECINTO, MONTANO OFACILITY TYPE:
740
ADDRESS:40147 GRENACHE CTTELEPHONE:
(570) 971-0448
CITY:MURRIETASTATE: CAZIP CODE:
92563
CAPACITY:0CENSUS: 0DATE:
09/11/2023
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Montano Recinto, Licensee TIME COMPLETED:
12:00 PM
ALLEGATION(S):
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Staff did not seek timely medical attention for resident.
INVESTIGATION FINDINGS:
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On 9/11/2023 Licensing Program Analyst (LPA) Javina George delivered findings for the allegation noted above. LPA met virtually with Licensee Montano Recinto, and explained the purpose of the visit and the elements of the allegation.

The allegation was investigated by the Department and conducted interviews with staff, residents, and other pertinent individuals. A review of facility documents and medical records indicated R1 sustained bilateral distal femur fractures in both legs from a fall sustained on 02/08/2020. Interviews revealed that staff sought timely medical attention for R1. As staff called 911 immediately after the fall due to R1 complaining of pain and appearing pale in color. Based on a review of documentation from the facility and the evidence gathered, it was determined the allegation is UNFOUNDED. A finding that the complaint is unfounded means that the allegation is false, could not have happened, and/or is without a reasonable basis. Therefore, the department had there dismissed the complaint. An exit interview was conducted and a copy of this report was provided to Montano Recinto, Licensee.

Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Joel EsquivelTELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Javina GeorgeTELEPHONE: (951) 204-7107
LICENSING EVALUATOR SIGNATURE:

DATE: 09/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 3