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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157206659
Report Date: 04/09/2024
Date Signed: 04/10/2024 08:36:04 AM

Document Has Been Signed on 04/10/2024 08:36 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, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME:NEW HORIZONS HOMES COMMUNITY CARE FAC.INC.#4FACILITY NUMBER:
157206659
ADMINISTRATOR/
DIRECTOR:		WYATT, LORIFACILITY TYPE:
735
ADDRESS:2008 FAIRVIEWTELEPHONE:
(661) 833-8386
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93304
CAPACITY: 6CENSUS: 4DATE:
04/09/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:37 PM
MET WITH:House Supervisor Joy Mackey and House Supervisor Angie GonzalezTIME VISIT/
INSPECTION COMPLETED:
03:00 PM
NARRATIVE
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Licensing Program Analyst Shawna Doucette (LPA) arrived at the facility unannounced to conduct a Required Annual inspection. LPA was met by House Supervisor Angie Gonzalez and House Supervisor Joy Mackey and was granted entry into the facility. LPA spoke with Administrator Rebecca Wood who gave permission for House Supervisor to handle the visit.

LPA conducted a tour inside and outside of facility. Facility observed to be clean, and at a comfortable temperature. Facility was set at 70 F. Common areas were furnished well with adequate seating and lighting available. Kitchen toured, appeared clean and safe for food preparation. Food supply checked, LPA observed an adequate supply of food. Resident rooms checked. LPA observed an adequate supply of linen. Hot water measured at 118.9 degrees F. Exterior tour conducted, all exits open and free of obstructions.

Fire extinguisher serviced on 1/17/2024. Smoke detectors and carbon monoxide detectors observed operational during today’s inspection. Last fire drill conducted 4/01/2024. Cleaning supplies were not locked and secured in a cabinet in the garage. Facility did not have a lock for the cabinet. Facility staff purchased a lock and the deficiency was cleared during the visit. Medications were locked on a cabinet in the kitchen.

Medications were reviewed. Staff files and Resident files were reviewed. Staff have CPR/First aid training.

Refer to 809D

An exit interview was conducted with the Administrator and a copy of this report with plans of correction and appeal rights were provided.

SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Shawna Doucette
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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Document Has Been Signed on 04/10/2024 08:36 AM - It Cannot Be Edited


Created By: Shawna Doucette On 04/09/2024 at 02:39 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.#4
FACILITY NUMBER: 157206659

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
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Based on observation, the licensee did not comply with the section cited above in facility not having a lock for the cleaning supplies for the cabinet in the garage, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 04/09/2024
Plan of Correction
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Licensee purchased a lock during the visit. POC cleared during visit.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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: 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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