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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157206660
Report Date: 04/20/2023
Date Signed: 04/25/2023 02:19:47 PM

Document Has Been Signed on 04/25/2023 02:19 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.#5FACILITY NUMBER:
157206660
ADMINISTRATOR:WYATT, LORIFACILITY TYPE:
735
ADDRESS:4512 HAHN AVENUETELEPHONE:
(661) 396-1371
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93309
CAPACITY: 6CENSUS: 4DATE:
04/20/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:54 PM
MET WITH:House Manager Joye Mackey
Administrator, Lori Wyatt		TIME COMPLETED:
02:12 PM
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Licensing Program Analyst (LPA) Darius Williams conducted an unannounced Annual Inspection Visit. LPA Williams emt with House Manager (HM), Joye Mackey and discussed the purpose of the visit. Administrator, Lori Wyatt arrived at a later time.

LPA Williams and HM toured the facility.

The tour began in the garage. The chemicals were locked behind a cabinet. Extra food was in refrigerator and freezers.

The dining room had seating available for all clients. The kitchen was clean and in good repair. Sharps and medications were locked in a cabinet door. Hot water temperature reflected approximately 106.4 degrees Fahrenheit. There were 2 day 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.

LPA Williams observed three of four bedrooms. The bedrooms were clean and in good repair. There were required linens on the bed, night stand, lamp, dresser, and chair.

The bathroom was clean, in good repair, and had non-slip mats.

The backyard had a covered area with seating available for all clients.

*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.#5
FACILITY NUMBER: 157206660
VISIT DATE: 04/20/2023
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Smoke detectors, carbon monoxide, and fire extinguishers were present and operational.

LPA Williams reviewed four client files and three employee files. All files reviewed had required documentation.

No deficiencies were cited at this time.

An exit interview was conducted and a copy of this report 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)
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