<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 275202153
Report Date: 12/14/2023
Date Signed: 12/19/2023 09:49:27 AM

Document Has Been Signed on 12/19/2023 09:49 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: 21DATE:
12/14/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Assistant Administrator, Richard MacasetTIME COMPLETED:
02:00 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 12/14/23, Licensing Program Analyst (LPA) Sarah Hurt conducted an unannounced case management at 12:45 hours. LPA met with facility Assistant Administrator, Richard Macaset. The purpose of this visit is to deliver the finding of review completed by the Department.

LPA conducted a tour of the facility, interior and exterior to ensure there are no potential or immediate health and safety risk at the facility.
On 04/04/2023, the Department received a copy of the death report (LIC 624A) dated 04/03/2023 indicating that a client/resident (C1) was found lifeless on bathroom floor on 04/02/2023. It was revealed that, on 03/26/2023, C1 was transported to hospital. According to the medical records, a facility staff member was given verbal discharge instructions over the phone for C1 to return to the hospital if C1 had any similar or worsening symptoms. Facility staff has admitted that on the night C1 passed away, C1 vomited at least once and C1 was asking to call 911. Facility staff did not call 911. In addition, on 03/26/2023, C1 was prescribed a nausea medication to be taken every six (6) hours. The facility records for April 2023 shows that facility staff provided this medication every four (4) hours.

Based on the review conducted by the Department and information gathered, the following deficiency was cited on LIC 809-D per the California Code of Regulations (CCR), Title 22, Division 6, Chapter 1. An immediate civil penalty of $500.00 was issued at this time and a copy of the LIC 421IM was given to Assistant Administrator, Richard Macaset.

At the time of the case management on 12/14/23, licensee was informed that the incident is currently under review and a future civil penalty may apply based on Health and Safety Code § 1548.

An exit interview was conducted, and a copy of this report dated 12/14/23 along with Appeal Rights (LIC 9058) was provided to Assistant Administrator, Richard Macaset whose signature below confirms receipt of these rights.
SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Sarah Hurt
LICENSING EVALUATOR SIGNATURE: DATE: 12/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/14/2023
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 12/19/2023 09:49 AM - It Cannot Be Edited


Created By: Sarah Hurt On 12/14/2023 at 01:12 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: 12/14/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/15/2023
Section Cited
CCR
80078(a)

1
2
3
4
5
6
7
CCR 80078(a)80078 RESPONSIBILITY FOR PROVIDING CARE AND SUPERVISION (a) The licensee shall provide care and supervision as necessary to meet the client's need.
This requirement is not met as evidenced by:
1
2
3
4
5
6
7
Licensee stated that facility staff training on meeting each client’s needs will be conducted on . Licensee agrees to develop a written plan of correction (POC) describing in writing how facility shall ensure compliance with CCR 80078 and how similar incident related to violation will be prevented in the future for health; safety and personal rights of clients. POC shall be received in licensing office by fax and/or mail by due date. Failure to meet POC due date may result in a civil penalty of $100 or more per day.
8
9
10
11
12
13
14
Based on interviews and reviews of evidence, licensee failed to provide care and supervision as necessary to meet C1’s need. Facility staff did not immediately telephone 9-1-1 when C1’s circumstance had resulted in an apparent life-threatening medical crisis which poses an immediate health; safety or personal rights to clients in care.

8
9
10
11
12
13
14

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
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: 12/14/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/14/2023


LIC809 (FAS) - (06/04)
Page: 2 of 2