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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015600127
Report Date: 01/25/2021
Date Signed: 01/25/2021 12:54:41 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME:NEW HORIZONS #3FACILITY NUMBER:
015600127
ADMINISTRATOR:SOFIA NEWFACILITY TYPE:
740
ADDRESS:5107 FOOTHILL BLVD.TELEPHONE:
(510) 479-3018
CITY:OAKLANDSTATE: CAZIP CODE:
94601
CAPACITY:6CENSUS: 6DATE:
01/25/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Cris Utleg/StaffTIME COMPLETED:
12:00 PM
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On this date, January 25, 2021, while at the facility for other reason, Licensing Program Analyst (LPA) Delmundo learned that Sofia New is no longer the administrator of the facility. Ms. New indicated she did not renew her administrator certificate.

LPA spoke with Rosario "Cherry" Utleg, licensee, and discussed the above. LPA also requested for copy of lease back agreement.

Licensee to submit the following for the change in administrator:
1. Signed letter indicating the change.
2. Copy of administrator certificate.
3. Copy of LIC508 Criminal Record Statement
4. LIC501 Personnel Record

All documents to be submitted by Friday, January 29, 2021.

Exit interview conducted and copy of this report provided to Cris Utleg.
SUPERVISOR'S NAME: Isaac TaggartTELEPHONE: (510) 363-5912
LICENSING EVALUATOR NAME: Alicia DelmundoTELEPHONE: (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.
LIC809 (FAS) - (06/04)
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