First Choice Senior Living

Allegation investigated: Staff are not being trained.

Licensing Program Analyst (LPA) Janira Arreola, conducted an unannounced visit to the facility in order to deliver findings on the above allegation. LPA met with staff, Dionisa Malang who was informed of the purpose of the visit. During the course of the investigation, the LPA conducted interviews, documented observations, and conducted records reviews. It was alleged that staff at the facility are not being trained. LPA reviewed the facility file and found that the facility currently has a hospice waiver and dementia care plan in the facility’s program plan. According to Section 87633(b)(6)(A) Hospice Care of Terminally Ill Residents, the staff should be receiving training on needs for hospice patients, turning and incontinence care. LPA reviewed the staff training provided and found that the staff do not have documented training in these topics. LPA reviewed the training for Staff #1 (S1), Staff #2 (S2) and Staff #3 (S3) and found that staff only have training on medication administration and Hoyer lift from a hospice agency. Substantiated LPA reviewed the facility’s dementia care plan and found that staff training is planned to be provided to “Caregivers…to assist in activities and to be aware of the special needs of the resident with dementia.” LPA reviewed the training for S1, S2 and S3 and found that there is no dementia care training for these staff on file. Per the Welfare and Institutions Code (WIC) and reviewed the requirements for training staff. WIC section 15655, employees of residential care facilities for the elderly must have training on mandated reporting. LPA interviewed the Licensee and inquired about staff receiving this training. The licensee stated that none of the staff had not received a mandated reporter training. Per California Code of Regulations Title 22 section 87411(c)(3)(C) Personnel Requirements- General, all staff are to receive training annually on resident personal rights. LPA interviewed the licensee who asked LPA if this training was a requirement and stated that none of their staff had received this training. Section 87411 states training can be conducted “on-the job”, and documentation of this should be kept in the staff’s file. S1 and S2 were interviewed and stated that S3 had provided on-the-job training in resident ADL’s (activities of daily living), however no documented training was found for these in staff files for S1 and S2. Based on the information provided, the LPA found that the facility was lacking mandated reporter training, care for individuals with dementia, and personal rights training. Therefore, the allegation was found to be substantiated. A finding that is substantiated means that the preponderance of the evidence standard has been met. The facility will receive deficiencies for missing staff trainings. These deficiencies were documented as Type B deficiencies, and plans of correction were made with the licensee. An exit interview was conducted where this report along with LIC809-D pages, and appeal rights were given to staff, Dionisa Malang.the state’s words, verbatim · CDSS document, Jun 7, 2023 · control 18-AS-20230306162606

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87405(h)(4) · Plan of correction due date: Jun 30, 2023

87405 Administrator - Qualifications and Duties (h) The administrator shall have the responsibility to: (4) Recruit, employ and train qualified staff…This requirment was not met as evidenced by: Based on administrator interview and personnel records review, it was found that staff have not receive the required training. It was found that administrator was unaware of the requirments for staff training. This is a potential personal right, health or saftey risk to the residents in care.the state’s words, verbatim · CDSS document, Jun 7, 2023

Plan of correction: The administrator agreed to send a self certified statement that they have read and understood the regulation section cited, as well as the regulation pertaining to required staff training. The administrator agreed to send the LPA the required training for all staff including themselves by the POC due date.

Type of visit: Case Management - Deficiencies

Licensing Program Analst (LPA) Janira Arreola conducted an unannounced visit in order to deliver findings for a complaint #18-AS-20230306162606. LPA met with staff, "Daisy" Dionisia Malang and informed them of the purpose of the visit. The LPA called the administrator over the phone, Montano Recinto. During the time of the visit there were (2) staff and (4) residents present. During the visit LPA found deficiencies unrelated to the complaint allegations. LPA found unlocked medications for staff and residents in the facility fridge. Additionally LPA found the facility has a fridge that is able to be locked that was kept unlocked with more resident medications. This deficiency was cited along with plan of correction. LPA also observed (1) jar of pasta sauce in the facility fridge that had a large black and green spot on the inside of the jar, about 1-inch in diameter. LPA checked the date that stated 12/2023. LPA opened the jar and showed staff a fuzzy green, gray and black spot on the inside. The staff threw the sauce away. The sauce was three-fourths of the way empty. This deficiency was cited as well as plan of correction for this. An exit interview was conducted with staff Dionisa Malang, where this report along with deficiency pages and appeal rights were reviewed and provided to them.the state’s words, verbatim · CDSS document, Jun 7, 2023

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87555(b)(9) · Plan of correction due date: Jun 8, 2023

(b) The following food service requirements shall apply: (9)Procedures which protect the safety, acceptability and nutritive values of food shall be observed in food storage, preparation and service. This requirment was not met as evidenced by: Based on observation LPA found (1) jar of pasta sauce that had green fuzzy spot inside the jar. The jar jad last been given to the residents The staff threw the jar away immediately. This poses an immediate personal rights, health or saftey risk to residents in car.the state’s words, verbatim · CDSS document, Jun 7, 2023

Plan of correction: The staff agreed to send the LPA a self certified statement that they would ensure all facility food in a safe and consumable state weekly by the POC due date.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87465(h)(2) · Plan of correction due date: Jun 8, 2023

(h) The following requirements shall apply to medications which are centrally stored: (2) Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees...This requirment was not met as evidenced by: Based on observation and staff interview, it was found that resident and staff medications are kept unlocked in the facility fridge. The facility has a designated fridge for medications that was found to be unlocked. This is an immediate health, saftey or personal rights risk.the state’s words, verbatim · CDSS document, Jun 7, 2023

Plan of correction: The facility staff agreed to send the LPA photos of the medications removed from the facility fridge and placed in the designated locked medication fridge. The staff agreed to send the LPA self certified statements that they would ensure all medication is kept in a locked place inaccesible to residents. This shall be sent to the LPA by the POC due date.

Allegation investigated: Uncleared staff working at the facility.

Licensing Program Analyst (LPA) Janira Arreola, conducted an unannounced visit to the facility in order to investigate the above allegations. LPA met with licensee, MontanoRecinto, who was informed of the purpose of the visit. During the visit, LPA conducted interviews, documented observations, and conducted records reviews. It was alleged that the staff at the facility do not have a fingerprint clearance with the department. LPA took down names of staff on duty during the visit, as well as reviewed the facility’s LIC500 Personnel report and Guardian Roster. LPA noted that all staff have been accounted for on the Guardian roster, and have documented background check with the department. Therefore, the allegation of "Uncleared staff working at the facility." is unsubstantiated. A finding of unsubstantiated means that although the allegation is valid, the proponderance of the evidence standard has not been met. An exit interview was conducted where this report was reviewed and provided to licensee, Montano Recinto. Unsubstantiatedthe state’s words, verbatim · CDSS document, Mar 14, 2023 · control 18-AS-20230306162606

The state marks this report as 2 pages; the online copy we transcribed has 1. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

On February 23, 2023, Licensing Program Analyst (LPA), Venus Mixson arrived at the above facility for an unannounced required annual with emphasis on infection control. LPA Mixson met with Facility Manager and state the purpose of the visit. LPA Mixson spoke with Administrator via the telephone, introduced self and stated the purpose of the visit. Present in the facility were six residents and two caregivers. There are currently no positive cases of COVID-19 within the facility. All staff and all residents are vaccinated. LPA Mixson toured the facility and made observations pertaining to the facility's infection control measures. LPA Mixson observed sufficient hand hygiene supplies, sufficient cleaning and disinfecting provisions, and the proper use of face coverings. The facility has a designated infection control lead person who has been tasked with tracking all COVID-19 cases and/or suspected cases, ensuring PPE supplies are maintained, and cleaning and disinfection provisions are in adequate quantities. Additionally, the facility has a plan in place to monitor resident's regularly for any changes in condition and to subsequently notify the resident's physician, and/or to notify all emergency agencies in the event of any COVID-19 related, or suspected illnesses. LPA Mixson later discussed infection control practices and procedures with Facility Manager. An exit interview was conducted and a copy of this report was given to Facility Manager.the state’s words, verbatim · CDSS document, Feb 23, 2023

Type of visit: Case Management - Health Checks

On 6/27/22 Licensing Program Analyst (LPA) Janira Arreola made an unannounced visit at the facility for the purpose of conducting a health and safety check. LPA Arreola met with Licensee Montano Recinto, and explained the purpose of the visit. At the time of the visit there was (3) staff and (4) residents present. LPA conducted a tour of the facility's interior and exterior. R1 was observed watching TV in the dinning room. R2, R3, and R4 were observed in their respective rooms. LPA observed the facility's food supply which met the requirements; 2 day supply of perishable and a 7 day supply of non-perishable food items. LPA observed a 30 day supply for resident's medications, and enough paper supply. LA observed a sufficient 30 day supply of PPE at the facility. No citations were issued t the time of the vistit concerning health and safety. An exit interview was conducted, and a copy of this report was provided to Licensee, Montano Recinto.the state’s words, verbatim · CDSS document, Jun 27, 2022

Type of visit: Office

Licensing Program Analyst (LPA) Janira Arreola and Licensing Program Manager (LPM) Joel Esquivel had an informal office meeting with Administrator Recinto Montano. The following issues were discussed: Complaints SUBSTANTIATED- Medication being administered without a prescription. Dead bolt used by Administrator in residents' rooms Case Management and SUBSTANTIATED Complaint- Staff using common area in facility such as pantry and closet as sleeping quarters Reporting requirements Technical Support Program (TSP) was offered and accepted by administrator at the time of the meeting . Administrator Montano Recinto agreed to correct the above issues and provide proof of compliance by June 15, 2022. A copy of this report was reviewed with the facility administrator, Montano Recinto and a copy was provided.the state’s words, verbatim · CDSS document, Jun 10, 2022

Allegation investigated: Facility utilizing closet as sleeping quarters for staff.

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 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.the state’s words, verbatim · CDSS document, May 4, 2022 · control 18-AS-20220428125557

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87307(a)(C) · Plan of correction due date: May 5, 2022

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.the state’s words, verbatim · CDSS document, May 4, 2022

Plan of correction: 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).

Allegation investigated: Staff are administering medication to resident without a prescription.

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. Substantiatedthe state’s words, verbatim · CDSS document, Jan 27, 2022 · control 18-AS-20220120081209

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(h)(6) · Plan of correction due date: Jan 31, 2022

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: 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.the state’s words, verbatim · CDSS document, Jan 27, 2022

Plan of correction: Licensee, will obtain a written prescription for all residents and provide proof by due date 1/31/22

Type of visit: Case Management - Other

On 1/27/22 Licensing Program Analysts (LPA) David Cuevas and Licensing Program Manager (LPM) Deborah Mullen arrived at the residence to check on the Health and Safety of residents. Upon arrival, LPAs met with Licensee, Montano Recinto and explained the purpose of the visit, who allowed entry. During visit LPA’s conducted a record review of resident files, reviewed resident medications and conducted an inspection of the facility. The following are deficiencies that were identify. · Front door has a keyed dead bolt, which LPA’s observed being locked by staff. · Fire Safety concerns- LPA’s observed a hall closet and a pantry next to kitchen being used as staff bedrooms. · Medication Issues- LPA’s observed medication being dispensed from a daily pill container instead of from the prescription container. · Client records- Records were incomplete missing several required documents, as well as physicians report missing responsible parties’ signatures. Based on observations and records review the facility will be cited deficiencies and civil penalties accessed. 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.the state’s words, verbatim · CDSS document, Jan 27, 2022

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.1(a)(6) · Plan of correction due date: Jan 27, 2022

(a) Residents in all residential care facilities for the elderly shall have all of the following personal rights:6) To leave or depart the facility at any time and to not be locked into any room, building, or on facility premises by day or night...This requirement was not being met as evidenced by: During visit to facility on 1/27/2022, LPA's observed the front door to have a keyed deadbolt prevently individuals from exiting the facility.This poses an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Jan 27, 2022

Plan of correction: Licensee will removed deadbolt located in the front door and provide proof of correction by 5:00pm on 1/27/2022.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87203 · Plan of correction due date: Jan 27, 2022

Fire Safety: All facilities shall be maintained in conformity with the regulations adopted by the State Fire Marshal for the protection of life and property against fire and panic...This requirement was not being met as evidenced by: During a facility inspection on 1/27/2022, LPA's observed a hall closet and the kitchen pantry being used as staff bedrooms. This poses a potential health and safety risk.the state’s words, verbatim · CDSS document, Jan 27, 2022

Plan of correction: Licensee will immidiately cease using hall closet and kitchen pantry as staff bedrooms by 5PM on 1/27/2022

From the deficiency page — Deficiency type: Type B · Section cited: CCR87465(h)(5) · Plan of correction due date: Feb 3, 2022

(h) The following requirements shall apply to medications which are centrally stored:(5)Each resident's medication shall be stored in its originally received container. No medications shall be transferred between containers.This requirement is not met evidence by: LPA observed Resident #6's medications to be stored in a daily pill container rather than the prescription bottle. This poses an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Jan 27, 2022

Plan of correction: Licensee will conduct training with staff to review regulation requirements with current and newly hired staff and submit proof of training by due date 2/3/22

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87506(a) · Plan of correction due date: Feb 3, 2022

87506(a) Resident Records. A separate, complete, and current record shall be maintained for each resident in the facility, readily available to facility staff and to licensing agency staff and shall contained specified information.This requirement was not met evidence by: Based on a review of resident records, Resident #1 through #5 were incomplete and missing required documents. This poses an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Jan 27, 2022

Plan of correction: Licensse will conduct an audit of current resident records and update as necessary. Proof of audit and updates must be presented to CCL by due date

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Yolanda Delgado made an unannounced visit to the facility to conduct an annual inspection with an emphasis on infection control. LPA arrived at 10:10 AM, LPA was met by caregiver Dionisia Malang and explained the purpose of the visit. Present in the facility during time of visit were two (2) staff as well as six (6) residents. Administrator Recinto arrived shortly later. There are currently no cases of COVID-19 within the facility. During today's visit, LPA toured the facility and made observations pertaining to the facility's infection control measures. LPA observed disinfecting provisions, and proper use of face coverings. The facility has a designated infection control lead person who has been tasked with tracking all COVID-19 cases and/or suspected cases, cleaning and disinfection provisions are in adequate quantities, and that staff are trained in the proper use and disposal of PPE and overall infection control. The facility has a plan in place which follows Community Care Licensing guidelines for when and how long to test staff and residents for COVID-19, when and how to isolate/quarantine residents, and when to schedule cleaning and disinfection times of high traffic and frequently touched areas. The facility also has a plan in place to subsequently notify the resident(s) physician and to notify all emergency agencies in the event of any COVID-19 related and/or suspected illnesses. Based on the observations made during today’s visit, Deficiencies and civil penalties were cited per Title 22, Division 6, of the California Code or Regulations. An exit interview to review this report was conducted and a copy of this report was provided.the state’s words, verbatim · CDSS document, Jan 3, 2022