306000502-9-27-2022-22-AS-LADS-CKAU8E-20221017152123

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306000502
Report Date: 09/27/2022
Date Signed: 09/27/2022 01:10:17 PM

Unsubstantiated

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
06/21/2022 and conducted by Evaluator Jerome Haley

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20220621171421

FACILITY NAME:	NEW HORIZON LODGE, INC.		FACILITY NUMBER:	306000502
ADMINISTRATOR:	GLEN E GOLDSMITH		FACILITY TYPE:	740
ADDRESS:	8541 CERRITOS AVENUE		TELEPHONE:	(714) 821-5781
CITY:	STANTON	STATE: CA	ZIP CODE:	90680
CAPACITY:	120	CENSUS: 69	DATE:	09/27/2022
		UNANNOUNCED	TIME BEGAN:	11:20 AM
MET WITH:	Sarah Zarate		TIME COMPLETED:	12:19 PM

ALLEGATION(S):

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Facility is not addressing residen'ts multiple falls.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jerome Haley made an unannounced visit to this facility to deliver findings on the complaint 22-AS-20220621171421. Upon entry, LPA Haley was explained the reason for the visit.

Please see findings below:

Regarding the allegation: Facility is not addressing residen'ts multiple falls.
During the initial 10 day visit on 6/27/22,LPA Haley interviewed Resident 1 (R1) who confirmed staff at New Horizon Lodge assist him while ambulating around the facility and make sure he's using his cane or wheelchair. During that visit LPA Haley interviewed two caregivers who confirmed they assist R1 with various activities during the day. Interviews with Administrator Glen Goldsmith and Assistant Administrator Sarah Zarate, revealed that R1 was taken to the hospital after falling 5/4/22, 5/26/22, & 6/19/22. Interviews with AD Goldsmith revealed R1 was being seen by a Home Health Nurse, and his responsible party (RP) was made aware of R1's falls.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Luz Adams	TELEPHONE: (714) 222-3821
LICENSING EVALUATOR NAME: Jerome Haley	TELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:	DATE: 09/27/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2022

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 22-AS-20220621171421

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: 09/27/2022

NARRATIVE

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Furthermore, Interviews with R1's RP revealed R1 was seen by a physician at the end of June, after his most recent fall at that time. It's unclear if the facility notified the RP after every fall or not.

Based on the information gathered during the investigation, review of all documents obtained, the Department is unable to ascertain if the allegation occurred as reported. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove or refute the alleged violation occurred; therefore, this allegation is deemed Unsubstantiated.

SUPERVISOR'S NAME: Luz Adams	TELEPHONE: (714) 222-3821
LICENSING EVALUATOR NAME: Jerome Haley	TELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:	DATE: 09/27/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2022

LIC9099 (FAS) - (06/04)

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