011440848-1-25-2021-15-AS-KHOS-BXPTWE-20210128140526

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 011440848
Report Date: 01/25/2021
Date Signed: 01/25/2021 01:02:25 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612

This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/21/2020 and conducted by Evaluator Alicia Delmundo

COMPLAINT CONTROL NUMBER: 15-AS-20201221164942

FACILITY NAME:	NEW HORIZONS (HOME #1 FOR THE AGED)		FACILITY NUMBER:	011440848
ADMINISTRATOR:	SOFIA NEW		FACILITY TYPE:	740
ADDRESS:	5115 FOOTHILL BLVD.		TELEPHONE:	(510) 261-1112
CITY:	OAKLAND	STATE: CA	ZIP CODE:	94601
CAPACITY:	15	CENSUS: 10	DATE:	01/25/2021
		UNANNOUNCED	TIME BEGAN:	12:00 PM
MET WITH:	Cris Utleg/Staff		TIME COMPLETED:	01:15 PM

ALLEGATION(S):

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Residents are locked in facility.

INVESTIGATION FINDINGS:

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On this day, January 25, 2021, Licensing Program Analyst (LPA) Delmundo arrived unannounced and met with Cris Utleg to deliver the finding on the allegation. LPA also spoke with Rosario Utleg, licensee, over the phone.

It was alleged that residents are locked in the facilty. It was reported that the front gate is locked with a paddle lock.

On December 24, 2020, LPA interviewed and conducted inspection with Sofia New. LPA observed the gate locked with a paddle lock. Ms. Sofia stated they’ve been locking the gate.

.......continued on LIC9099C

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Isaac Taggart	TELEPHONE: (510) 363-5912
LICENSING EVALUATOR NAME: Alicia Delmundo	TELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:	DATE: 01/25/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/25/2021

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 15-AS-20201221164942

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612

FACILITY NAME: NEW HORIZONS (HOME #1 FOR THE AGED)	FACILITY NUMBER: 011440848
	VISIT DATE: 01/25/2021

NARRATIVE

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Based on the information obtained, the allegation 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.

Deficiency is cited from Title 22 California Code of Regulations (see 9099D). Any repeat violations within 12-month period may result in civil penalties.

Deficiency and plan and proof of correction were discussed with Rosario Utleg over the phone in the presence of Cris Utleg

Exit interview conducted. Appeal Rights and copy of this report provided.

SUPERVISOR'S NAME: Isaac Taggart	TELEPHONE: (510) 363-5912
LICENSING EVALUATOR NAME: Alicia Delmundo	TELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:	DATE: 01/25/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/25/2021

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 15-AS-20201221164942

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612

FACILITY NAME: NEW HORIZONS (HOME #1 FOR THE AGED)	FACILITY NUMBER: 011440848
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/25/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 02/08/2021 Section Cited CCR 87468.1(a)(6)	1 2 3 4 5 6 7	87468.1 Personal Rights of Residents in All Facilities: (a) Residents in all residential care facilities for the elderly shall have... 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 does not prohibit a licensee from establishing house rules, such as locking	1 2 3 4 5 6 7	Lock on gate was removed. Licensee to do in-service training and submit proof by 2/08/2021.
	8 9 10 11 12 13 14	doors at night to protect residents, or barring windows against intruders, with permission from the Department. This requirement is not met as evidenced by: -Based on interview and observation, the licensee did not comply with the above Regulation by locking the gate which poses potential personal rights risk to persons in care.	8 9 10 11 12 13 14
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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: Isaac Taggart	TELEPHONE: (510) 363-5912
LICENSING EVALUATOR NAME: Alicia Delmundo	TELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:	DATE: 01/25/2021

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/25/2021

LIC9099 (FAS) - (06/04)

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