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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336407734
Report Date: 12/20/2021
Date Signed: 12/20/2021 02:30:14 PM

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:PICO DE LOROFACILITY NUMBER:
336407734
ADMINISTRATOR:VIVIEN RILLO/EFREN RILLOFACILITY TYPE:
740
ADDRESS:620 NORTH PERRIS BLVDTELEPHONE:
(951) 943-8081
CITY:PERRISSTATE: CAZIP CODE:
92571
CAPACITY:39CENSUS: 14DATE:
12/20/2021
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Vivien Rillo - AdministratorTIME COMPLETED:
02:45 PM
NARRATIVE
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Licensing Program Analyst (LPA) Crystal Colvin arrived at the facility for the purpose of delivering findings for an open complaint investigation (#18-AS-20200911162021), for which LPA Colvin additionally observed a violation of Title 22 Regulations during the investigation of the complaint.

For this complaint, a resident (R1) was admitted to the hospital in June 2020 due to having contracted COVID-19 and needing additional medical treatment. Once the hospital was ready to discharge R1, the Licensee refused to readmit R1 due to R1 still testing positive for COVID-19, and having concern that R1 was going to infect the other residents. R1's Power of Attorney (POA) attempted without success to have R1 brought back to the facility, and R1 was eventually forced to be admitted to a Skilled Nursing Facility (SNF), where R1 remained for 100 days, due to not being able to return to the facility until testing negative for COVID-19. Since R1 was discharged from the hospital, R1 did not need additional medical care, and therefore, did not have reason to be admitted to an SNF other than not having a place to go, since the facility refused to readmit R1 at the time of discharge. This was a violation of R1's personal rights. Deficiency cited.

LPA Colvin conducted an exit interview with Administrator Vivien Rillo where a copy of this report, LIC809D, and appeal rights were provided.
SUPERVISOR'S NAME: Joel EsquivelTELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Crystal ColvinTELEPHONE: (951) 204-0848
LICENSING EVALUATOR SIGNATURE:

DATE: 12/20/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2021
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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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: PICO DE LORO
FACILITY NUMBER: 336407734
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/20/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/21/2021
Section Cited

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Additional Personal Rights of Residents in ...Facilities: (a) In addition to the rights listed ... residents...shall have all of the following personal rights: (20) To be protected from involuntary transfers, discharges, and evictions.... This requirement was not met ass evidenced by:
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Based on interviews conducted, the Licensee did not comply with the above regulation with one resident. The Licensee refused to readmit R1 after hospital discharge due to R1 being positive for COVID-19. R1 was subsequently transferred to SNF. This was an immedaite personal rights violation of R1.
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unsure of if the situation calls for denial of readmittance to the facility, the Licensee agrees to consult with Licensing to ensure residents' rights are preserved and to prevent undue harm. Licensee to provide LPA Colvin with Statement of Understanding by the Plan of Correction date of 12/21/21.

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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: Crystal ColvinTELEPHONE: (951) 204-0848
LICENSING EVALUATOR SIGNATURE:
DATE: 12/20/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/20/2021
LIC809 (FAS) - (06/04)
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