FAMILY CHOICE SENIOR LIVING

Official classification

Type B

Official code

87411(a)

Regulation authority

CCR

What the official deficiency says

Personnel Requirements 87411(a) (a) Facility personnel shall at all times be sufficient in numbers... In facilities licensed for sixteen or more, sufficient support staff shall be employed... Additional staff shall be employed as necessary to perform office work, cooking, house cleaning, laundering... This requirement was not met as evidence by: Based on record review and interviews, the facility personnel has not been at sufficient numbers due to not having support staff. Which poses a potential health and safety risk to residents in care.

Official plan of correction

Licensee stated they will send LPA weekly staffing schedules of 3 caregivers and 1 medtech on duty and hire a house cleaner by POC due date.

Deadline recorded: Apr 3, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87211(a)(1)

Regulation authority

CCR

What the official deficiency says

Reporting Requirements 87211(a)(1) A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence... This requirement was not met as evidence by: Based on records reviewed and interview, LPA observed incident reports that were not submitted to the Regional Office regarding R1s fall. This poses a potential health, safety or personal rights risk to residents in care.

Official plan of correction

Licensee stated they will submit an in service conducted with staff and a statement of understanding to LPA by POC due date.

Deadline recorded: Mar 27, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87555(b)(16)

Regulation authority

CCR

What the official deficiency says

General Food Service Requirements 87555(b)(16) In facilities licensed for sixteen (16) to forty-nine (49) residents, one person shall be designated who has primary responsibility for food planning, preparation and service. This person shall be provided with appropriate training. This requirement was not met as evidence by: Based on interview, observation and records review the facility did not have a designated cook with appropriate training and was pulling caregivers for cooking duties. This poses a potential health, safety or personal rights risk to residents in care.

Official plan of correction

Licensee provided LPA with an updated LIC 500 with 2 cooks on shift 7 days a week. LPA observed a cook in the facility. This citation was cleared.

Deadline recorded: Mar 27, 2026. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87468.1(11)

Regulation authority

CCR

What the official deficiency says

87468.1(11) Personal Rights of Residents in All Facilities (11) To have their visitors... permitted to visit privately during reasonable hours and without prior notice, provided that the rights of other residents are not infringed upon. This requirement was not met as evidence by: Upon interviews with R1 it was revealed that they wanted W1 to come visit them at the facility, but W1 was asked to leave by the AD upon arrival. This poses an immediate personal rights violation to residents in care.

Official plan of correction

Licensee stated they will do a signed statement of understanding on the regulation violated and send to LPA by POC due date.

Deadline recorded: Jan 8, 2026. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87468.1(a)(1)

Regulation authority

CCR

What the official deficiency says

87468.1 Personal Rights of Residents in All Facilities (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (1) To be accorded dignity in their personal relationships with staff, residents, and other persons. This requirement was not met as evidenced by: Facility staff witnessing Staff 5 ignoring questions from Resident 7, Staff members have witnessed S5 respond to R7 when other staff felt there should have been no response to the resident from S5. Staff 1 and Staff 5 have both been accused of yelling at R7.

Official plan of correction

Executive Director Junge will conduct an in-service training on Personal Rights for Residents in All Facilities for all staff. Provide a sign in sheet and a summary of the topics covered during the training and the duration of the in service training to LPA Haley by 4:00pm on the POC due date.

Deadline recorded: Oct 23, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

Maintenance and Operation: 87303(a) The facility shall be clean, safe, sanitary and in good repair at all times. The Licensee did not comply with the section cited above due to the presence of an accessible collapsed fence on the side of the house. This poses a potential safety risk to persons in care.

Official plan of correction

Administrator stated they will repair the fence and ensure the side of the house is inaccessible to residents in care by the assigned plan of corrections due date of December 9, 2024.

Deadline recorded: Dec 9, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87465(c)(2)

Regulation authority

CCR

What the official deficiency says

Incidental Medical and Dental Care - 87465(c)(2) Once ordered by the physician the medication is given according to the physician's directions. The Licensee did not comply with the section cited above due to the presence of a missed medication dose in one resident's medication. LPAs observed the dose was signed off on the Medication Administration Record, indicating it was administered.

Official plan of correction

Administrator stated they will conduct an in-service training regarding Medication Administration and Documentation by the assigned due date. LPA advised AD to document the training with the following information: date/time the training was conducting, participating staff and topics covered. AD stated they will email LPA all documentation for this training by the assigned Plan of Correction due date of December 9, 2024.

Deadline recorded: Dec 9, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87211(a)(1)(D)

Regulation authority

CCR

What the official deficiency says

(1) A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of any of (D) Any incident which threatens the welfare, safety or health of any resident, such as psychological abuse of a resident by staff or other residents, or unexplained absence of any resident. This requirement is not met as evidenced by: Deficient Practice Statement Based on record review, the licensee did not comply with the section cited above. The Licensee did not report Resident 1's elopement or hospitalization due to elopement. This poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/06/2024 Plan of Correction Administrator stated they will conduct an in-service training regarding Reporting Requirements by the assigned due date. LPA advised AD to document the training with the following information: date/time the training was conducting, participating staff and topics covered. AD stated they will email LPA all documentation for this training by the assigned Plan of Correction due date of December 6, 2024.

Official classification

Type B

Official code

87411(a)

Regulation authority

CCR

What the official deficiency says

87411 Personnel Requirements - General (a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. This requirement was not met as evidenced by: Based on record review, LPA determined R1 was found outside of the facility while seizing. R1 was transported to a hospital via EMS.

Official plan of correction

Administrator stated they will conduct an in-service training regarding supervision of residents and a review of functional capabilities of all residents for all facility staff by the assigned due date. LPA advised AD to document the training with the following information: date/time the training occurred, participating staff and topics covered. AD stated they will email LPA all documentation for this training by the assigned Plan of Correction due date of December 9, 2024.

Deadline recorded: Dec 9, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87463(a)

Regulation authority

CCR

What the official deficiency says

The pre-admission appraisal shall be updated, in writing as frequently as necessary to note significant changes and to keep the appraisal accurate... This requirement is not being met as evidenced by: Based on interviews conducted, Licensee failed to ensure R1 was re-assessed for suitability to return to the facility. R1 was re-assessed 18 days after potential discharge. This poses an immediate health and safety risk to residents in care.

Official plan of correction

Licensee to read regulation an submit a statement of understanding nto LPA by POC due date. Licensee to submit a written plan on how to address situations that arise at the facility and forward to LPA by POC due date.

Deadline recorded: Apr 11, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87405(d)(1)

Regulation authority

CCR

What the official deficiency says

The administrator shall have the qualifications specified in Sections 87405(d)... Knowledge of the requirements for providing care and supervision appropriate to the residents. This requirement is not being met as evidenced by: Based on interviews conducted, Licensee failed to ensure facility has a qualified administrator. Administrator allowed R1 to remain at hospital for 18 days without following up with licensing or hospital affecting R1's finances and/ or ALW. This poses an immediate health and safety risk.

Deadline recorded: Apr 11, 2024. A deadline is not proof that correction was completed.