157206657-4-10-2024-24-AS-LPAT-D47L5E-20240410082659

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 157206657
Report Date: 04/09/2024
Date Signed: 04/10/2024 08:27:21 AM

Document Has Been Signed on 04/10/2024 08:27 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
FRESNO RO, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME:	NEW HORIZONS HOMES COMMUNITY CARE FAC. INC. #2		FACILITY NUMBER:	157206657
ADMINISTRATOR/ DIRECTOR:	WYATT, LORI		FACILITY TYPE:	735
ADDRESS:	409 SPERRY STREET		TELEPHONE:	(661) 792-3831
CITY:	BAKERSFIELD	STATE: CA	ZIP CODE:	93307
CAPACITY: 6		CENSUS: 6	DATE:	04/09/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:29 AM
MET WITH:	Dodie Franklin, Supervisor		TIME VISIT/ INSPECTION COMPLETED:	02:15 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst L. Padgett (LPA) , conducted an unannounced annual visit to the facility and met with Supervisor (Sup) Dodie Franklin. LPA stated the purpose of the visit and was accompanied by Sup while conducting the inspection of the facility. At the time of the visit, LPA observed 3 residents in the facility. LPA with Sup toured the kitchen. LPA observed that the kitchen was well maintained, with working lights and well maintained appliances. The kitchen counters and sink are free from debris. LPA observed that refrigerator, was well maintained and clean. LPA observed extra freezer with extra food supply. LPA observed a 2 day perishable food supply. Facility uses two standing cabinet to store dry food and juices. Cabinets were clean, organized, and had 7 days of non-perishable food. No expired food was observed. Medications are stored in locked cabinet. LPA observed the dining room is well lit, and the table and can seat six people. LPA inspected the living room with Sup. Fireplace was observed but Sup states it is not utilized. Television was observed to be in a secure place, the living room floor has carpet in good condition. LPA observed adequate sofas and a chair. The living room can accommodate at least 8 people. The living room has a window that is kept clean and is not obstructed. The furniture was clean and in good condition. Cleaning supplies are stored in entryway closet. LPA entered the office. At 10:45am LPA observed an open cabinet inside, LPA observed a small storage bin with kitchen knives. Sup placed the knives in the medication cabinet and locked it during this visit.

SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Lissett Padgett
LICENSING EVALUATOR SIGNATURE:	DATE: 04/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2024

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
FRESNO RO, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: NEW HORIZONS HOMES COMMUNITY CARE FAC. INC. #2	FACILITY NUMBER: 157206657
	VISIT DATE: 04/09/2024

NARRATIVE

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LPA observed the hallway that leads to the bedrooms. This facility does not use night lights, they leave the hall light on at night. Smoke detectors, and carbon monoxide detector were tested and found to be functioning. LPA observed thermostat reading at 73 degrees F.

A fire extinguisher is mounted on the wall in laundry room and inspected on 1/17/2024 with the correct pressure gauge as indicated on the meter.

LPA inspected the hallway bathroom and observed that the bathroom is well maintained, well lit, and in good condition. Water temperature measured at 110.3 degrees F. The bathroom was observed to have non-skid mat, grab bars, grip bar next to toilet, faucets, shower. The toilet mechanism is in working condition. LPA observed the linen closet next to the bathroom have clean towels and linens.

LPA inspected the 3 resident’s bedrooms with Sup. LPA observed Bedroom #1 is shared, appeared clean and organized and had required furniture.
Bedroom #2 is shared, appeared clean and well organized, has a private bathroom with covered trash bin, non-skid floor. The bedroom is well lit, and had required furniture.
Bedroom #3 is shared, appeared clean and with required furniture.

LPA with caregiver, inspected the backyard. LPA, observed that the backyard is well maintained, trees, bushes and grass in good condition. Patio furniture is clean and ready for use. The exterior walkways are free from obstructions and debris.

First aid kit was inspected and found to be in compliance per regulation to have tweezer, bandages, manual, scissors and wound ointments.

Deficiencies were cited during today's visit per California Code of Regulations (CCR) Title 22. An exit interview was conducted with Sup. A copy of the signed report and appeals rights were provided.

LPA is requesting the following documents be submitted to the Fresno CCL office by 4/23/24: Current copy of Administrator Certificate, Designation of Facility Responsibility (LIC308), Administrator Organization (LIC 309), Affidavit regarding Client/Resident Cash Resources (LIC 400), Liability Insurance, Emergency and Disaster Plan (LIC 610E) Personnel Report (LIC500), Register of Facility Clients/Residents for (LIC9020A), Surety Bond.

SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Lissett Padgett
LICENSING EVALUATOR SIGNATURE:	DATE: 04/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2024

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 04/10/2024 08:27 AM - It Cannot Be Edited

Created By: Lissett Padgett On 04/09/2024 at 01:44 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. #2	FACILITY NUMBER: 157206657
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/09/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

CCR

80087(g)

Building and Grounds

(g) Disinfectants, cleaning solutions, poisons, firearms and other items that could pose a danger if readily available to clients shall be stored where inaccessible to clients. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on LPA's observation of knives stored in open container in unlocked office cabinet, the licensee did not comply with the section cited above which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 04/09/2024
	Plan of Correction
1 2 3 4	Deficiency was corrected during this visit. Supervisor stored knives in locked kitchen cabinet.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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:

Lissett Padgett

LICENSING EVALUATOR SIGNATURE:

DATE: 04/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2024

LIC809 (FAS) - (06/04)

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