157206658-3-29-2023-24-AS-SDOE-CQDR8U-20230329124829

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 157206658
Report Date: 03/29/2023
Date Signed: 03/29/2023 12:48:35 PM

Document Has Been Signed on 03/29/2023 12:48 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. #3		FACILITY NUMBER:	157206658
ADMINISTRATOR:	WYATT, LORI		FACILITY TYPE:	735
ADDRESS:	2800 RICE		TELEPHONE:	(661) 871-9681
CITY:	BAKERSFIELD	STATE: CA	ZIP CODE:	93306
CAPACITY: 6		CENSUS: 5	DATE:	03/29/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	DSP Ashley Williams, House Supervisor Angela Gonzalez, Administrator Lori Wyatt		TIME COMPLETED:	01:00 PM

NARRATIVE

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Licensing Program Analyst LPA Shawna Doucette arrived at the facility unannounced to conduct the Required Annual Inspection. LPA met with Administrator Lori Wyatt. LPA disclosed the purpose of the inspection and was granted entry into the facility by DSP Ashley Williams.

A tour of the facility was conducted with House Supervisor Angela Gonzalez. The residence was set at 68 F temperature and free of passageway obstructions inside and outside.

LPA Doucette observed 3 bedrooms in the residence. Residents' rooms were toured and inspected. Rooms were found to be clean. Hot water temperature was measured 110.9 F.

Kitchen toured, supply of food observed and food stored properly for perishable and nonperishable. Knives were stored in a locked cabinet. Medications were stored in a locked Medication cabinet. Cleaning supplies were in a locked closet. First Aid Kit contained the required supplies. Smoke detectors and carbon monoxide detectors were checked and operating. Fire extinguishers were charged and had service dates of 1/17/23. Fire drill was last completed on 3/06/23.

LPA observed a self latching gate on the outside of the residence. There was outdoor seating for the residents.

Resident and staff records were reviewed. Current first aid and CPR were on file for staff.

Per Title 22, citation was issued for incomplete resident records. Refer to 809D.

An exit interview was conducted with House Supervisor Angela Gonzalez. A copy of this report was left with House Supervisor Angela Gonzalez, whose signature on this form confirm receipt of these documents.

SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Shawna Doucette
LICENSING EVALUATOR SIGNATURE:	DATE: 03/29/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/29/2023

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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Document Has Been Signed on 03/29/2023 12:48 PM - It Cannot Be Edited

Created By: Shawna Doucette On 03/29/2023 at 12:24 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. #3	FACILITY NUMBER: 157206658
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/29/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

80069(c)(1)

Client Medical Assessments

(c) The medical assessment shall include the following: (1) The results of an examination for communicable tuberculosis and other contagious/infectious diseases. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review and staff interview, the licensee did not comply with the section cited above of 2 out of 5 clients which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 04/14/2023
	Plan of Correction
1 2 3 4	Licensee agrees to submit a copy of the physicans report with TB results for C1 and C2 by POC due date 4/14/23.

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:

Shawna Doucette

LICENSING EVALUATOR SIGNATURE:

DATE: 03/29/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/29/2023

LIC809 (FAS) - (06/04)

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