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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 275202153
Report Date: 05/06/2024
Date Signed: 05/08/2024 11:18:31 AM

Document Has Been Signed on 05/08/2024 11:18 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/
DIRECTOR:		BENJAMIN MACASAETFACILITY TYPE:
735
ADDRESS:1121 E. LAUREL DR.TELEPHONE:
(831) 758-2139
CITY:SALINASSTATE: CAZIP CODE:
93905
CAPACITY: 30CENSUS: 22DATE:
05/06/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
04:15 PM
MET WITH:Administrator, Jose VitanTIME VISIT/
INSPECTION COMPLETED:
06:00 PM
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Licensing Program Analyst (LPA) Sarah Hurt conducted a Case Management visit. LPA met with facility Facility Administrator, Jose Vitan and explained the purpose of today's visit.

LPA Hurt is following up on an incident from 04/20/2024 involving Resident 1 causing them to be hospitalized. LPA Hurt reviewed Resident 1's Physicians Report, Centrally Stored Medication Log, and Medication Administration Records. Resident 1's Physician Report documents they need assistance with Administering Medications.

Resident 1 was in the hospital beginning 04/20/2024 Administrator stated Resident 1's medications that weren't taken when hospital was hospitalized were given to the pharmacy, and was not documented on Centrally Stored Medication log. LPA Hurt was unable to count the medications for Resident 1 as they were given to the pharmacy. Facility staff was not correctly documenting Centrally Stored Medications for Resident 1. Resident 1's Centrally Stored Medication log also documents medication # 406389 to be given at noon, and bedtime. Facility staff signed for Resident 1's medication #406389 at 9 p.m., but consistently did not sign for the noon medication.


The following deficiencies are being cited Per Title 22 Regulations.

Exit interview conducted with facility Administrator, Jose Vitan, and a copy of this report provided.
SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Sarah Hurt
LICENSING EVALUATOR SIGNATURE: DATE: 05/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/06/2024
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 05/08/2024 11:18 AM - It Cannot Be Edited


Created By: Sarah Hurt On 05/06/2024 at 05:31 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: 05/06/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/20/2024
Section Cited
CCR
87878

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80075 Health Related Services
(a) The licensee shall ensure that each client receives necessary first aid and other needed medical or dental services, including arrangement for and/or provision of transportation to the nearest available services.(7) The licensee shall ensure the maintenance, for each client, of a record of centrally stored prescription medications which is retained for at least one year and includes the following:(A) The name of the client for whom prescribed.(B) The name of the prescribing physician.(C) The drug name, strength and quantity.(D) The date filled.
(E) The prescription number and the name of the issuing pharmacy. (F) Expiration date.(G) Number of refills.
The following requirement has not been met as evidenced by:


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Administrator Jose Vitan will submit training for staff on medication management and submit to LPA Hurt by POC date of 05/20/2024.
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Resident 1's medication not taken during hospitalization was given back to the pharmacy, but not documented correctly. which poses a potential, health, safety, or personal rights risk to residents 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:Brenda Chan
LICENSING EVALUATOR NAME:Sarah Hurt
LICENSING EVALUATOR SIGNATURE:
DATE: 05/06/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/06/2024


LIC809 (FAS) - (06/04)
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