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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157206659
Report Date: 04/20/2023
Date Signed: 04/25/2023 02:14:17 PM

Document Has Been Signed on 04/25/2023 02:14 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.#4FACILITY NUMBER:
157206659
ADMINISTRATOR:WYATT, LORIFACILITY TYPE:
735
ADDRESS:2008 FAIRVIEWTELEPHONE:
(661) 833-8386
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93304
CAPACITY: 6CENSUS: 4DATE:
04/20/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:38 AM
MET WITH:House Manager, Dodie Franklin
Administrator Lori Wyatt		TIME COMPLETED:
12:18 PM
NARRATIVE
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Licensing Program Analyst (LPA) Darius Williams conducted an unannounced Annual Inspection visit. LPA Williams met with House Manager (HM), Dodie Franklin and discussed the purpose of the visit. Administrator Lori Wyatt appeared at a later time.

The HM toured the facility with LPA Williams.

The dining room had seating available for all clients.

The kitchen was clean and in good repair. There was two days of perishable food and one week of non-perishable food.

The living room was clean and in good repair. There was seating available for all clients.

The living room flowed into the backyard. There was a covered area present and seating available for all clients. The gates were self latching and were not obstructed. There is no pool on the premises.

There are two bathrooms in the facility. Both bathrooms were clean, good repair, and non-slip mats present.

There were three bedrooms. Two of three bedrooms were clean and in good repair. Client 1's bedroom has approximately 8 quarter size black stains on the carpet. HM reported they are scheduling a carpet cleaner to address the issue. Appropriate linens, dresser, lights, lamps, and night stands were present.

*Continued on LIC-809 C*
SUPERVISORS NAME: Serigy Pidgirny
LICENSING EVALUATOR NAME: Darius Williams
LICENSING EVALUATOR SIGNATURE: DATE: 04/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/20/2023
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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.#4
FACILITY NUMBER: 157206659
VISIT DATE: 04/20/2023
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Smoke detectors, carbon monoxide, and fire extinguisher were present and operational.

LPA Williams reviewed 4 clients files. Client 2 was missing the signature page of the Admission agreement. Client 4 was missing a full Admission agreement and full medical assessment.

The HM and Administrator reported the documents may have been misplaced.

Based on today's inspection, deficiencies were cited in the areas evaluated and listed on the LIC 809D page, according to California Code of Regulations Title 22, Division 6. Plan of Correction was developed and reviewed with HM.

An exit interview was conducted and a copy of this report and appeal rights will be provided via e-mail.
SUPERVISORS NAME: Serigy Pidgirny
LICENSING EVALUATOR NAME: Darius Williams
LICENSING EVALUATOR SIGNATURE:

DATE: 04/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/20/2023
LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 04/25/2023 02:14 PM - It Cannot Be Edited


Created By: Darius Williams On 04/20/2023 at 02:03 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: 04/20/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/28/2023
Section Cited
CCR
80068(a)

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(a) The licensee shall complete an individual written admission agreement with each client and the client's authorized representative, if any.

This requirement is not met as evidenced by:
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HM has agreed to contact Kern Regional Center for Admission Agreements for Client 2 and Client 4. HM has agreed to submit the signed Admission agreements to the department by POC due date of 4/28/2023.
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Based on record review, the licensee did not comply with the section cited above in 2 out of 4 persons (Client 2 and 4) which posed a potential health, safety or personal rights risk to persons in care.
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Type B
04/28/2023
Section Cited
CCR85068.2(b)(1)(C)

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(b) If the client is to be admitted, then prior to admission... (1) The client's desires and background, obtained from the client, ...appropriate, regarding the following: (C) The written medical assessment specified in Section 80069.

This requirement is not met as evidenced by:
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HM scheduled appointment on the same day, 4/20/2023. HM has agreed to submit copy of medical assessment to the department by POC due date of 4/28/2023.
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Based on record review, the licensee did not comply with the section cited above in 1 out of 4 persons (Client 4) which poses a potential health, safety or personal rights risk to persons 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:Serigy Pidgirny
LICENSING EVALUATOR NAME:Darius Williams
LICENSING EVALUATOR SIGNATURE:
DATE: 04/20/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/20/2023


LIC809 (FAS) - (06/04)
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