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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015600127
Report Date: 10/01/2021
Date Signed: 05/12/2022 02:31:19 PM

Document Has Been Signed on 05/12/2022 02:31 PM - It Cannot Be Edited

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:ROSARIO UTLEGFACILITY TYPE:
740
ADDRESS:5107 FOOTHILL BLVD.TELEPHONE:
(510) 479-3018
CITY:OAKLANDSTATE: CAZIP CODE:
94601
CAPACITY: 6CENSUS: 0DATE:
10/01/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:35 AM
MET WITH:Rosario Utleg, LicenseeTIME COMPLETED:
12:35 PM
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***THIS IS AN AMENDED REPORT FROM ORIGINAL ON 10/1/2021***

On 10/1/2021 at 11:35 AM, Licensing Program Analyst (LPA) L. Francisco conducted a Case Management visit as a result of licensee requested closure of the facility. Upon arrival, LPA was greeted by Care Staff, Jenny Tiangco. Licensee, Rosario Utleg later arrived at 11:50 AM.

A 60-day closure notice was issued to all residents on July 30, 2021. LPA toured entire facility with Care Staff including kitchen, bathrooms, bedrooms, common areas, backyard LPA confirmed all residents have moved out. Licensee surrendered the licence during the closure visit and will submit relocation evaluation to CCL no later than 10/8/2021.

A forfeiture letter will be mailed to licensee at a later time. Exit interview conducted and a copy of this report provided via email.
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Lizette Francisco
LICENSING EVALUATOR SIGNATURE: DATE: 10/01/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/01/2021
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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