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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157206659
Report Date: 06/22/2023
Date Signed: 06/23/2023 08:34:15 AM

Document Has Been Signed on 06/23/2023 08:34 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:WYATT, LORIFACILITY TYPE:
735
ADDRESS:2008 FAIRVIEWTELEPHONE:
(661) 833-8386
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93304
CAPACITY: 6CENSUS: 4DATE:
06/22/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:44 PM
MET WITH:Dodie Franklin, House ManagerTIME COMPLETED:
04:00 PM
NARRATIVE
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On 06/22/23, Licensing Program Analyst (LPA) L. Salazar arrived at the facility unannounced to conduct a case management visit. LPA was greeted by Staff S1, stated the purpose of this visit and was allowed entry into the home. LPA observed 2 residents in the home at the time of visit. House manager arrived to the facility a few minutes later.

LPA received an incident report stating Resident R1 had arrived at day program with moldy food in their lunch. Facility also self reported this incident. LPA interviewed R1, who stated the food was left over from the previous day, that was left in the lunch box. R1 stated they do not make their own lunches. Interviews with staff also state the moldy food in the lunch box was left over from the prior day's lunch.

LPA toured the facility and observed a 2 day supply of perishables and 7 day supply of non-perishables. None of the food observed in the facility was found to be moldy. LPA observed two cabinets with non-perishable food in the kitchen. The cabinets were observed to have padlocks. The padlocks were unlocked, however, they were observed to be hanging from the latches on the cabinet. S1 stated the locks are used during the night shift because residents get up in the middle of the night and eat.

Based on LPA's observation and interviews conducted and In accordance with the California Code of Regulations, Title 22, Chapter 6 Division 8, deficiencies are being cited on the attached LIC 809-D.

An exit interview was conducted and plan of correction was developed with House Manager with a due date of 06/30/23. A copy of this report and appeal rights were discussed and left with House Manager.
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Lisa Salazar
LICENSING EVALUATOR SIGNATURE: DATE: 06/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/22/2023
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 06/23/2023 08:34 AM - It Cannot Be Edited


Created By: Lisa Salazar On 06/22/2023 at 02:45 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: 06/22/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/30/2023
Section Cited
CCR
80076(a)(7)

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Food Services
(a) In facilities providing meals to clients, the following shall apply:
Commercial foods shall be approved by appropriate federal, state and local authorities. All foods shall be selected, transported, stored, prepared and served so as to be free from contamination and spoilage and shall be fit for human consumption. Food in damaged containers shall not be accepted, used or retained. This requirement was not met as evidenced by LPAs interviews with staff and observation of self reporting that R1's lunch box had leftover food with mold from a previous day's lunch.
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House Manager will provide LPA with new procedures including a checklist evidencing staff has checked the resident's lunch boxes each day. The checklist will show 7 days of staff compliance and verification that lunch boxes are cleaned out daily.
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Type B
06/30/2023
Section Cited
CCR80072(a)(3)

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To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse, or other 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.
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Locks were immediately removed and latches will be removed from the cabinets by POC date. House Manager contacted maintenance during LPAs visit. House Manager will send pictures evidencing latches have been removed by POC.
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This requirement was not met as evidenced by LPA's interview with Staff S1 and observation of padlocks hanging from the kitchen cabinets, which stored non perishable snacks for resident's 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:Melinda Hoffmann
LICENSING EVALUATOR NAME:Lisa Salazar
LICENSING EVALUATOR SIGNATURE:
DATE: 06/22/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/22/2023


LIC809 (FAS) - (06/04)
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