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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306000502
Report Date: 09/21/2020
Date Signed: 09/21/2020 11:35:42 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:NEW HORIZON LODGE, INC.FACILITY NUMBER:
306000502
ADMINISTRATOR:GLEN E GOLDSMITHFACILITY TYPE:
740
ADDRESS:8541 CERRITOS AVENUETELEPHONE:
(714) 821-5781
CITY:STANTONSTATE: CAZIP CODE:
90680
CAPACITY:120CENSUS: 92DATE:
09/21/2020
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Glen Goldsmith, AdministratorTIME COMPLETED:
11:29 AM
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Licensing Program Analyst (LPA) Jim August contacted the facility via video telephone due to COVID-19 and precautionary measures and to follow up on an incident that occurred on Friday September 18, 2020. LPA identified himself and discussed the purpose of the visit with Administrator (AD.) Glen Goldsmith.

At approximately 5:20PM on September 18, 2020, a motorist was in a police chase that ended at the parking lot at the south east corner of the facility. The facility parking entrance is on Cerritos Ave to the side of the building. The Orange County Sheriff pursued the suspect and opened fire on the suspect in the parking lot of the facility. The suspect was killed.

The facility dining room faces Cerritos Ave where some residents were still eating dinner when the incident occurred. A stray bullet, or possibly a ricochet struck one of the front sliding glass doors of the dining room. The doors are double paned and the object only broke the first pane of the door. There was no other damage observed by facility staff. None of the facility staff or residents were injured in the incident.
One resident, (R1) was outside the facility taking a walk and witnessed the incident. As soon as facility staff became aware of what was happening, they immediately moved residents away front the front of the building and towards the lobby or other secure areas. Facility staff made sure R1 and other residents were ok. Facility staff offered to send R1 to the hospital for mental health or stress management but R1 refused. R1 has been monitored all weekend and is doing fine.

Facility maintenance will be repairing the door as soon as possible. AD. Goldsmith will be providing an in service training to all staff as part of the quarterly emergency drills to train staff on the appropriate actions for staff to take on incidents such as this. No deficiencies are being cited during today's visit. An exit interview was conducted with AD. Goldsmith via video telephone and a copy of this report, along with LIC811 will be provided to AD. Goldsmith via email. AD. Goldsmith to sign the report and scan/email back to LPA August within 24 hours.
SUPERVISOR'S NAME: Sheila SantosTELEPHONE: (714) 703-2857
LICENSING EVALUATOR NAME: James AugustTELEPHONE: 714-703-2853
LICENSING EVALUATOR SIGNATURE:

DATE: 09/21/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2020
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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