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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157206656
Report Date: 08/21/2024
Date Signed: 08/21/2024 05:57:46 PM

Document Has Been Signed on 08/21/2024 05:57 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, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME:NEW HORIZONS HOMES COMMUNITY CARE FAC. INC. #1FACILITY NUMBER:
157206656
ADMINISTRATOR/
DIRECTOR:		WYATT, LORIFACILITY TYPE:
735
ADDRESS:3618 COLUMBUS STREETTELEPHONE:
(661) 871-9447
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93306
CAPACITY: 6CENSUS: 5DATE:
08/21/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:58 AM
MET WITH:House Manager Joye MackeyTIME VISIT/
INSPECTION COMPLETED:
01:30 PM
NARRATIVE
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Licensing Program Analyst (LPA) Shawna Doucette arrived at the facility to conduct a Case Management for an incident that occurred on 08/3/24.

LPA reviewed and obtained a copy of facility internal investigation with statements regarding the incident. LPA interviewed Staff and Clients.

On 8/4/24 it was reported to S4 and S5, S1 threatened C1 with his fist on 8/3/24 sometime in between 4:10 PM to 9:45 PM.

According to statements obtained, S1 left on 08/3/24 at 09:45 hours and did not return until 11 PM leaving 1 staff to 5 clients. S1 returned to the facility, appearing intoxicated. S1 was later found showering and vomiting in C1's bathroom. S1 was yelling at staff and clients in care.

According to statements obtained, S1 was in C3's face gripping his shoulders and yelling at C3 to go to his room.

Refer to 809d for deficiencies.

A copy if this report was provided with plans of correction and appeal rights.
SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Shawna Doucette
LICENSING EVALUATOR SIGNATURE: DATE: 08/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/21/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
Document Has Been Signed on 08/21/2024 05:57 PM - It Cannot Be Edited


Created By: Shawna Doucette On 08/21/2024 at 12:42 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: NEW HORIZONS HOMES COMMUNITY CARE FAC. INC. #1
FACILITY NUMBER: 157206656

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/21/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/22/2024
Section Cited
CCR
85065.5(a)(1)

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85065.5 Day Staff-Client Ratio (a) Whenever a client who relies upon others to perform all activities of daily living is present, the following minimum staffing requirements shall be met:(1) For Regional Center clients, staffing shall be
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Plan of Correction Licensee agrees to conduct a staff training on reporting and will provide a written statement on how this regulation will be met in the future by POC due date 8/22/24
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 maintained as specified by the Regional Center but no less than one direct care staff to three such clients. This requirement was not met as evidenced by Licensee had 1 staff for 5 clients on 8/3/24 from 9:45 PM to 11 PM which poses an immediate health safety and or personal rights risk to clients in care.
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Type A
08/22/2024
Section Cited
CCR80072(a)(3)

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80072 Personal Rights (a) Except for children’s residential facilities, each client shall have personal rights which include, but are not limited to, the following:(3) To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse, or other
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Plan of Correction Licensee agrees to conduct a training on personal rights and abuse by POC due date
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actions of a punitive nature, including but not limited to: interference with the daily living functions, including eating, sleeping, or toileting; or withholding of shelter, clothing, medication or aids to physical functioning. This requirement was not met as evidenced by Licensee did not ensure C1 and C3 were free from intimidation/threat which poses an immediate health safety and or personal rights risk to clients in care.
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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:Sergiy Pidgirny
LICENSING EVALUATOR NAME:Shawna Doucette
LICENSING EVALUATOR SIGNATURE:
DATE: 08/21/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/21/2024


LIC809 (FAS) - (06/04)
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