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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191204505
Report Date: 08/29/2022
Date Signed: 08/29/2022 03:32:26 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 08/29/2022 03:32 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, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:NEW HORIZONS HOMEFACILITY NUMBER:
191204505
ADMINISTRATOR:NANCY SOOHOO OR CRIS SCHLAFACILITY TYPE:
735
ADDRESS:15756 PARTHENIA STREETTELEPHONE:
(818) 894-9301
CITY:NORTH HILLSSTATE: CAZIP CODE:
91343
CAPACITY: 12CENSUS: 9DATE:
08/29/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Elizabeth OsorioTIME COMPLETED:
11:15 AM
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LPA Spaeth conducted an unannounced visit to the facility and was greeted by caregiver. LPA stated the purpose of the visit was to conduct an annual visit. Caregiver called the Administrator, Tracy Kennedy at 9:50 am. LPA explained previously conducted an annual inspection on 8/19/2022 by mistake at the next door New Horizons location (15746 Parthenia Street) as opposed to the 15756 Parthina Street location. During LPA's visit, LPA observed caregiver was wearing a mask and confirmed there are nine residents and all residents were participating in various events within the community. The caregiver recorded LPA's temperature and requested LPA answer the COVID questions on the sign-in sheet. Administrator stated there are two buildings and the set-up in each building is the same. Both buildings contain a living area, dining room, and kitchen combination at the entrance of each building. There is a staff bathroom, pantry room, laundry room, and the residents' bedrooms. The bedrooms are set up for two residents with a halfway wall set up for resident's privacy along with a bathroom to share.

LPA and the caregiver began the tour at 9:55 am with the Administrator, Tracy Kennedy on the phone. LPA observed a med cart was located in both locations and were locked. Within the kitchen, there were a five-day supply of fresh fruits and vegetables located in each refrigerator of both buildings.. The cleaning chemicals were locked underneath the kitchen sink. The pantry in each building contained a 7-day supply of non-perishable canned goods, a locked cabinet which contained the knives, PPE supplies and hygiene items for the residents. .
The laundry detergent was locked in a cabinet above the washer and dryer in both locations. LPA observed the residents' rooms were neat a clean and contained bed, linens, lamp, night stand, and closet. The resident bathrooms contained slip resistant mats in the shower, hand soap, wash your hands sign, paper towels, and a trash can. The public/staff bathroom contained a walk in shower with slip resistant mat, paper towels, wash your hands, soap, paper towels and a trash can. LPA observed the outside gates were not lock. There are no deficiencies to report at this time. Exit interview conducted, appeal rights discussed, and a copy of the report was given to the caregiver.
SUPERVISORS NAME: Cassandra Harris
LICENSING EVALUATOR NAME: Melissa Spaeth
LICENSING EVALUATOR SIGNATURE: DATE: 08/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/29/2022
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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