015600740-3-19-2025-15-AS-GLUK-DEWPB5-20250319110948

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 015600740
Report Date: 03/19/2025
Date Signed: 03/19/2025 11:09:55 AM

Document Has Been Signed on 03/19/2025 11:09 AM - 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:	A NEW HAVEN CARE HOME		FACILITY NUMBER:	015600740
ADMINISTRATOR/ DIRECTOR:	ROBERT ABELLA		FACILITY TYPE:	740
ADDRESS:	949 DOLORES STREET		TELEPHONE:	(925) 606-6244
CITY:	LIVERMORE	STATE: CA	ZIP CODE:	94550
CAPACITY: 6	TOTAL ENROLLED CHILDREN: 0	CENSUS: 4	DATE:	03/19/2025
TYPE OF VISIT:	Case Management - Other	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	10:15 AM
MET WITH:	Arnold Soleta, Licensee		TIME VISIT/ INSPECTION COMPLETED:	11:20 AM

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Licensing Program Analyst (LPA) G. Luk conducted an unannounced case management visit as a follow-up to a substantiated allegation on September 21, 2022. LPA met with Licensee, Arnold Soleta and explained the purpose of the visit.

On September 21, 2022, the Department concluded a complaint investigation and substantiated an allegation that resident (R1) sustained a stage 4 pressure injury while in care.

On September 21, 2022, the licensee was cited for violating Health and Safety Code (HSC) §1569.269(a)(10) Enumerated rights, severability.

The Department concluded an analysis and has determined that a civil penalty is warranted for serious bodily injury. Per Welfare and Institutions Code § 15610.67, serious bodily injury is defined as “an injury involving extreme physical pain, substantial risk of death, or protracted loss or impairment of a function of a bodily member, organ, or of mental faculty, or requiring medical intervention, including but not limited to, hospitalization, surgery, or physical rehabilitation. This is evidenced by the facility did not change R1’s diapers and reposition R1 which resulted in R1 sustaining a stage 4 pressure injury on their coccyx requiring pain control.

(Continue on LIC809C...)

Harpreet Humpal	TELEPHONE: (510) 285-3928
Grace Luk	TELEPHONE: (510) 286-4201
	DATE: 03/19/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/19/2025

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

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

FACILITY NAME: A NEW HAVEN CARE HOME	FACILITY NUMBER: 015600740
	VISIT DATE: 03/19/2025

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Today March 19, 2025, the Department will be issuing a civil penalty per Health and Safety Code for a violation that the Department constitutes as serious bodily injury in the amount of $10,000.00. However, since an immediate civil penalty of $500.00 was previously issued on September 21, 2022, the amount of the civil penalty issued today will be $9,500.00.

Exit interview conducted. A copy of the report issued. Appeal rights provided. Licensee, Arnold Soleta and signature on this report acknowledges receipt of the appeal rights, found on page two of LIC 421D.

SUPERVISOR'S NAME: Harpreet Humpal	TELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: Grace Luk	TELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:	DATE: 03/19/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/19/2025

LIC809 (FAS) - (06/04)

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