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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306000502
Report Date: 11/09/2020
Date Signed: 11/09/2020 04:58:57 PM



STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/04/2020 and conducted by Evaluator Kathrina Chin
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20200804141451
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: 79DATE:
11/09/2020
UNANNOUNCEDTIME BEGAN:
02:25 PM
MET WITH:Glen Goldsmith, Executive DirectorTIME COMPLETED:
05:30 PM
ALLEGATION(S):
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1) Facility mismanaged resident's medications.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA), Kathrina Chin contacted the facility via telephone for the purpose of presenting the findings of the complaint investigation due to COVID-19 and pre-cautionary measures. LPA Chin identified herself and discussed the findings with Glen Goldsmith, Executive Director.

Allegation 1- Facility mismanaged resident's medications

An initial visit was made on August 11, 2020. On August 11, 2020 and November 4, 2020, LPA interviewed Alexondra Carrillo, Wellness Coordinator and Glen Goldsmith, Executive Director and both admitted that resident 1 did not receive medications on certain days. On November, 4, 2020, Ms. Carillo stated that resident did not receive her medication Duloxetineon from August 1 though August 4, 2020 because the resident #1 (R1) needed to switch psychiatrist and need a new prescription orders which caused a delay in ordering the medications for R1. The medication is given one capsule given once daily. R1 did not receive her medication for a total of four days. (Continued LIC 9099-C)
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Sheila SantosTELEPHONE: (714) 703-2838
LICENSING EVALUATOR NAME: Kathrina ChinTELEPHONE: (714) 703-2840
LICENSING EVALUATOR SIGNATURE:

DATE: 11/09/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2020
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 6
Control Number 22-AS-20200804141451
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		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
VISIT DATE: 11/09/2020
NARRATIVE
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LPA interviewed resident 2 (R2) and resident 6(R6) in which they reported staff have missed giving them their medication.

Resident 2 missed medications for nine days in July or August of 2020. R2 did not receive his hypertension medication, Losartan for nine days. He further added that in August 2020, staff #3 only gave him three medications when he is suppose to get six pills every morning.

LPA interviewed resident 6 (R6) who reported that staff missed one day of his Balcofen- a spasticity medication because they ran out of the medication and the facility also ran out Lidocane for his back. R6 said that this is for his back pain. R6 further added that staff need to order the medications prior to running out. Staff fail to refill the medications on time.


Therefore, based on the information gathered through interviews and review of pertinent records, the allegation that the facility mismanaged resident's medications is found to be substantiated.


See LIC 9099D for cited deficiencies per Title 22, Division 6 of the California Code of Regulations.


An exit teleconference was conducted with Glen Goldsmith, Executive Director and LPA, Chin discussed and read this report and appeal rights explained. A copy of this report will be provided via email including a copy of appeal rights. Mr. Goldsmith agreed to confirm the receipt of the document and return a signed copy.
SUPERVISOR'S NAME: Sheila SantosTELEPHONE: (714) 703-2838
LICENSING EVALUATOR NAME: Kathrina ChinTELEPHONE: (714) 703-2840
LICENSING EVALUATOR SIGNATURE:

DATE: 11/09/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2020
LIC9099 (FAS) - (06/04)
Page: 2 of 6
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/04/2020 and conducted by Evaluator Kathrina Chin
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20200804141451

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: 79DATE:
11/09/2020
UNANNOUNCEDTIME BEGAN:
02:25 PM
MET WITH:Glen Goldsmith, Executive DirectorTIME COMPLETED:
05:30 PM
ALLEGATION(S):
1
2
3
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5
6
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9
2) Staff are not following physician's orders.
3) Staff are not meeting the incontinence needs of the resident.
4) Staff are not sufficient in numbers and competent to provide services necessary to meet the need of residents.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA), Kathrina Chin contacted the facility via telephone for the purpose of presenting the findings of the complaint investigation due to COVID-19 and pre-cautionary measures. LPA Chin identified herself and discussed the findings with Glen Goldsmith, Executive Director.

Allegation 2- Staff are not following physician's orders. It was alleged that resident was not repositioned every two to three hours as ordered by the resident's physician.

An initial visit was made on August 11, 2020. LPA interviewed six residents and three staff persons. Glen Goldsmith, Executive Director explained that resident 1 (R1) is repositioned every two to three hours or as needed. R1 is a very picky with the staff who assists her and will decline assistance from a male staff or female staff that she does not like. Mr. Goldsmith further explained that he has purchased a special call bell for R1 to use to seek assistance from staff when additional help is needed. (Continued LIC 9099-C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Sheila SantosTELEPHONE: (714) 703-2838
LICENSING EVALUATOR NAME: Kathrina ChinTELEPHONE: (714) 703-2840
LICENSING EVALUATOR SIGNATURE:

DATE: 11/09/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2020
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 6
Control Number 22-AS-20200804141451
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		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
VISIT DATE: 11/09/2020
NARRATIVE
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Mr. Goldsmith stated that R1 has lived in a long term skilled nursing facility and is unfamiliar with an Assisted Living facility in which they do not provide three and a half hours of care per resident each day. LPA interviewed staff 2 (S2) said that resident is repositioned 2 to 3 hours as needed. LPA reviewed R1's physician report, discharge documents, and pre-admission appraisal and there were no orders from the physician indicating that R1's needs to be repositioned every two to three hours. LPA interviewed six residents and no concerns noted. Resident 1 (R1), Resident 3(R3) and Resident 6(R6) are wheelchair bound and require two person assist. R3 and R6 reported that they are given the care and assistance they need and they have no issues. Both further indicated that they push the call button when they need additional any assistance from staff.

The Department has investigated the complaint alleging that staff are not following physician's orders. Based on the information gathered during the investigation and review of all documents obtained, the allegation is deemed unsubstantiated. Although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation did or did not occur.

Allegation 3 - Staff are not meeting the incontinence needs of the resident.

An initial visit was made on August 11, 2020. LPA interviewed six residents and three staff persons. Glen Goldsmith, Executive Director explained that resident 1 (R1) is changed every two or three hours and as needed for her incontinent care. R1 is very picky with the staff who assists her and will decline assistance from a male staff and female staff that she does not like. Mr. Goldsmith further explained that he has purchased a special call bell for R1 when she needs assistance.

LPA interviewed six residents and no concerns noted. Resident 3 and Resident 6 are wheelchair bound and require two person assist. R3 and R6 also require incontinent care and they said that they just need to request staff when they have an accident or need changing more often. R3 and R6 reported that they are given the care and assistance they need.

The Department has investigated the complaint alleging that staff are not meeting the incontinence needs of the resident. Based on the information gathered during the investigation and review of all documents obtained, the allegation is deemed unsubstantiated. Although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation did or did not occur. (Continued on LIC 9099C)
SUPERVISOR'S NAME: Sheila SantosTELEPHONE: (714) 703-2838
LICENSING EVALUATOR NAME: Kathrina ChinTELEPHONE: (714) 703-2840
LICENSING EVALUATOR SIGNATURE:

DATE: 11/09/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2020
LIC9099 (FAS) - (06/04)
Page: 4 of 6
Control Number 22-AS-20200804141451
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		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
VISIT DATE: 11/09/2020
NARRATIVE
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Allegation 4 - Staff are not sufficient in numbers and competent to provide services necessary to meet the need of residents.

Glen Goldsmith, Executive Director stated that they have sufficient staff and that he is continuously hiring staff when needed. LPA reviewed the LIC 500 Personnel Summary form and Mr. Goldsmith stated that he has two to three caregivers in every shift and one Medtech in every shift. LPA interviewed six residents and no concerns were indicated.

Resident 4(R4) and Resident 5(R5) indicated that they see staff work overtime often in order to provide the necessary care and supervision to the residents. LPA also interviewed R7 who is President of the Resident Council and R8 who is the Vice President of the Resident Council of the facility and both did not have any concern regarding staffing issues.

LPA interviewed two employees. One Medication Technician and one Wellness Coordinator. Both employees reported that they have sufficient staff at the facility. Glen Goldsmith, Executive Director reported that two new caregivers have been hired but both are in training currently.

The Department has investigated the complaint alleging that staff are not sufficient in numbers and competent to provide services necessary to meet the needs of residents.

Based on the information gathered during the investigation and review of all documents obtained, the allegation is deemed unsubstantiated. Although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation did or did not occur.

An exit teleconference was conducted with Glen Goldsmith, Executive Director and LPA Chin discussed and read this report. A copy of this report will be provided via email as well as appeal rights. Mr. Goldmith agreed to confirm the receipt of the document, review the report and return a signed copy.
SUPERVISOR'S NAME: Sheila SantosTELEPHONE: (714) 703-2838
LICENSING EVALUATOR NAME: Kathrina ChinTELEPHONE: (714) 703-2840
LICENSING EVALUATOR SIGNATURE:

DATE: 11/09/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2020
LIC9099 (FAS) - (06/04)
Page: 5 of 6
Control Number 22-AS-20200804141451
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/09/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/09/2020
Section Cited
CCR
87465(a)(5)
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 Incidental Medical and Dental Care- The licensee shall assist residents with self-administered medications as needed. The facility failed to dispense the medications for R1. This requirement is not met as evidenced by interviews, the facility staff admitted that R1 missed her medication, Duloxetineon for four days.
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Glen Goldsmith, Executive Director stated that staff will receive in-service training on medication for staff handling and dispensing medications to residents. Licensee will submit a statement to LPA indicating how they intend to adhere to it by the POC due date.
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 from August 1 to August 4, 2020. The facility failed to get a new physician orders and failed to order the medications from the pharmacy on a timely basis. This poses an immediate risk to the health and safety of residents in care.
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CCR
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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: Sheila SantosTELEPHONE: (714) 703-2838
LICENSING EVALUATOR NAME: Kathrina ChinTELEPHONE: (714) 703-2840
LICENSING EVALUATOR SIGNATURE:

DATE: 11/09/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2020
LIC9099 (FAS) - (06/04)
Page: 6 of 6