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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 275202153
Report Date: 08/07/2023
Date Signed: 08/18/2023 10:31:41 AM

Document Has Been Signed on 08/18/2023 10:31 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
FRESNO ASC, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME:NEW HORIZON, A.R.F.FACILITY NUMBER:
275202153
ADMINISTRATOR:BENJAMIN MACASAETFACILITY TYPE:
735
ADDRESS:1121 E. LAUREL DR.TELEPHONE:
(831) 758-2139
CITY:SALINASSTATE: CAZIP CODE:
93905
CAPACITY: 30CENSUS: 24DATE:
08/07/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:35 PM
MET WITH:Assistant Administrator, Richard MacasetTIME COMPLETED:
06:00 PM
NARRATIVE
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Licensing Program Analysts Sarah Hurt and Miriam Flores (LPA'S) conducted an unannounced visit today for the facility’s annual inspection. LPA met with Assistant Administrator, Richard Macaset, Continual Administrator's Certification expires 05/16/2024. There are currently 24 residents who reside at this home. LPA's inspected the interior and the exterior of the facility including the common living spaces, resident bedrooms and bathrooms, activity rooms. Food supply is adequate for 2-day perishable and 7-day nonperishable.

LPA's observed toxins and cleaning supplies accessible to residents through outside side gate leading into an area onto the side of the kitchen. LPA's observed medications accessible to residents through an unlocked side gate leading into the facility kitchen area. LPA's observed several mattresses in disrepair, and without sheets or bedding. LPA's observed several facility windows to be missing screens or screens have rips and tears. LPA'S observed facility fire extinguishers last serviced September 2021. LPA's observed the facility resident bathrooms to be in disrepair with black mold in the shower of resident hallway bathroom. LPA's observed spider webs with spiders in facility bathrooms. LPA's observed the facility resident bedrooms to be dirty, including walls to be extremely dirty, and drapes (sheets covering windows.) LPA's observed several resident dressers to be broken. LPA's observed food storage containers inside the facility refrigerator without dates or labels. LPA's observed several food containers in facility kitchen to be dirty. LPA's observed facility resident bathrooms water temperature was tested at 125 degrees. This facility does not perform disaster drills as required.


Continued on 809C..
SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Sarah Hurt
LICENSING EVALUATOR SIGNATURE: DATE: 08/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/07/2023
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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Document Has Been Signed on 08/18/2023 10:31 AM - It Cannot Be Edited


Created By: Sarah Hurt On 08/07/2023 at 04:01 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 HORIZON, A.R.F.
FACILITY NUMBER: 275202153

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/07/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
80087(g)
80087 Buildings 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 LPA's observed toxins, and cleaning supplies accesible to residents which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 08/08/2023
Plan of Correction
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Licensee agrees to store toxins, and cleaning aupplies in an area inaccesible to residents, and send proof to LPA's by 08/08/2023.
Type A
Section Cited
CCR
80020(a)

80020 Fire Clearance
(a) All facilities shall secure and maintain a fire clearance approved by the city or county fire department, the district providing fire protection services, or the State Fire Marshal.
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 LPA's observed facility fire extinguishers last serviced 09/2021 (more than a year ago) which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 08/08/2023
Plan of Correction
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Licensee agrees to have facility fire extinguishers serviced and send proof to LPA's by 08/08/2023 POC date.
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:Brenda Chan
LICENSING EVALUATOR NAME:Sarah Hurt
LICENSING EVALUATOR SIGNATURE:
DATE: 08/07/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/07/2023


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Document Has Been Signed on 08/18/2023 10:31 AM - It Cannot Be Edited


Created By: Sarah Hurt On 08/07/2023 at 04:16 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 HORIZON, A.R.F.
FACILITY NUMBER: 275202153

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/07/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
85088(c)(1)
85088 (c)(1)

(1) An individual bed, except that couples shall be allowed to share one double or larger sized bed, maintained in good repair, and equipped with good bed springs, a clean mattress and pillow(s).

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 LPA's observed Resident mattress to be broken which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/21/2023
Plan of Correction
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Licensee agrees to provide facility residenta a mattress in good repair and send proof to LPA by 08/21/2023 POC date.
Type B
Section Cited
CCR
8588(c)(4)
8588 Furniture, Fixture, and Supplies

(4) Clean linen in good repair, including lightweight, warm blankets and bedspreads; top and bottom bed sheets; pillow cases; mattress pads; rubber or plastic sheeting, when necessary; and bath towels, hand towels and washcloths.
This requirement is not met as evidenced by:
Deficient Practice Statement
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Based observation, the licensee did not comply with the section cited above in LPA's observed residents with no bedding sleeping on plastic mattress pad, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/21/2023
Plan of Correction
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Licensee agrees to provide clean bedding for all facility residents and provide proof to LPA by 08/21/23
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:Brenda Chan
LICENSING EVALUATOR NAME:Sarah Hurt
LICENSING EVALUATOR SIGNATURE:
DATE: 08/07/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/07/2023


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Document Has Been Signed on 08/18/2023 10:31 AM - It Cannot Be Edited


Created By: Sarah Hurt On 08/07/2023 at 04:23 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 HORIZON, A.R.F.
FACILITY NUMBER: 275202153

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/07/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
80087(a)


80087 Buildings and Grounds
(a) The facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors.

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 LPA's observed facility resident bedrooms to be extremely dirty, bathrooms are extremely dirty, facility bathrooms have broken vanities, facility bathrooms have broken tiles, facility kitchen area is dirty, the facility side yard has trash and overgrown weeds, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/21/2023
Plan of Correction
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Licensee agrees to clean facility bathrooms, bedrooms, and kitchen and send proof to LPA by 08/21/2023 POC date.
Type B
Section Cited
CCR
80088(e)(1)
80088 Furniture , Fixtures, Equipment, and Supplies
(b) All window screens shall be in good repair and free of insects, dirt, and other debris.

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 LPA's observed facility window screens to be missing, broken, and torn which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/21/2023
Plan of Correction
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Licensee agrees to replace, and repair all missing and broken window screens and send proof to LPA by 08/21/2023 POC date.
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:Brenda Chan
LICENSING EVALUATOR NAME:Sarah Hurt
LICENSING EVALUATOR SIGNATURE:
DATE: 08/07/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/07/2023


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Document Has Been Signed on 08/18/2023 10:31 AM - It Cannot Be Edited


Created By: Sarah Hurt On 08/07/2023 at 04:32 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 HORIZON, A.R.F.
FACILITY NUMBER: 275202153

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/07/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
80088(e)(1)
Furniture, Fixture, and Supplies
Hot temoerature controls should to automatically regulate temperature of hot water delivered to plumbing fixtures used by cients to attain a hot water temperatiure of not less than 105 degrees and not more than 120 degrees.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observaton the licensee did not comply with the section cited above in LPA's observed facility water temperature to be 125 degrees which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 08/08/2023
Plan of Correction
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Licensee will send proof to LPA of water temeperature being under 120 degrees and send proof to LPA by 08/08/23 POC date.
Type A
Section Cited
CCR
80087(k)(1)
80087(k)(1)
Health related services

(1) Medication shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication.

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 LPA's observed resident medications accessible to residents, and staff not responsible for the supervision of centrally stored medications which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 08/08/2023
Plan of Correction
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Licensee agrees to keep centrally stored medications in an area not accessible to residents or employees not responsible for the supervision of medications and send proof to LPA by 08/08/23 POC date.
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:Brenda Chan
LICENSING EVALUATOR NAME:Sarah Hurt
LICENSING EVALUATOR SIGNATURE:
DATE: 08/07/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/07/2023


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Document Has Been Signed on 08/18/2023 10:31 AM - It Cannot Be Edited


Created By: Sarah Hurt On 08/07/2023 at 04:42 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 HORIZON, A.R.F.
FACILITY NUMBER: 275202153

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/07/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
80076(16)
80076 Food Services

(16) Soaps, detergents, cleaning compounds or similar substances shall be stored in areas separate from food supplies.
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 LPA's observed cleaning supplies including bleach in close promximity to facility food supply, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/21/2023
Plan of Correction
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Licensee agrees to clean facility side area next to kitchen and remove cleaning supplies by POC date of 08/21/23
Type B
Section Cited
CCR
80087(18)
80087 Food Services
(18) All food shall be protected against contamination. Contaminated food shall be discarded immediately.

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 LPA's observed several containers with food to be dirty with no labels or dates, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/21/2023
Plan of Correction
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Licensee agrees to train facility staff on food preparation, and contanimation and send proof to LPA's by POC date of 08/21/23.
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:Brenda Chan
LICENSING EVALUATOR NAME:Sarah Hurt
LICENSING EVALUATOR SIGNATURE:
DATE: 08/07/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/07/2023


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 08/18/2023 10:31 AM - It Cannot Be Edited


Created By: Sarah Hurt On 08/07/2023 at 04:51 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 HORIZON, A.R.F.
FACILITY NUMBER: 275202153

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/07/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
80023(d)
80023 Disaster and Mass casualty plan
(d) Disaster drills shall be conducted at least every six months.
This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on records reviewed, the licensee did not comply with the section cited above in LPA's reviewed disaster drill documents and the facility has not performed disaster drills in more than 6 months (since 2021) which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/21/2023
Plan of Correction
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Licensee agrees to perform required disaster drills and send proof to LPA's by POC date of 08/21/23
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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3
4
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:Brenda Chan
LICENSING EVALUATOR NAME:Sarah Hurt
LICENSING EVALUATOR SIGNATURE:
DATE: 08/07/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/07/2023


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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
FRESNO ASC, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME: NEW HORIZON, A.R.F.
FACILITY NUMBER: 275202153
VISIT DATE: 08/07/2023
NARRATIVE
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...Continued


The following deficiencies were observed or cited during today's inspection per California Code of Regulations, Title 22.

LPA's requested the following documents: LIC 500 Personnel Report, LIC 308 Designation of Administrative Responsibility, LIC 610 the Emergency Disaster Plan and copy of current Administrator’s Certificate to update the facility file. Listed documents shall be sent to Licensing.

Exit interview conducted with Assistant Administrator Richard Mascant and copy of report left at facility
SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Sarah Hurt
LICENSING EVALUATOR SIGNATURE:

DATE: 08/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2023
LIC809 (FAS) - (06/04)
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