306000502-9-22-2022-22-AS-LADS-CPWMRA-20230314095002

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306000502
Report Date: 09/22/2022
Date Signed: 09/22/2022 12:44:16 PM

Unfounded

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
12/09/2021 and conducted by Evaluator Albert Marin

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20211209161303

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: 68	DATE:	09/22/2022
		UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Administrator Glen Goldsmith		TIME COMPLETED:	11:15 AM

ALLEGATION(S):

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Staff failed to provide a safe environment for resident.
Staff failed to meet resident's needs.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Albert Marin made an unannounced visit to this facility to deliver the final report for the investigation completed for the complaint filed last December 12, 2021 against this facility. LPA met with Administrator (AD) Glen Goldsmith and stated the purpose of this visit; and discussed the following findings.

On allegation that staff failed to provide safe environment for the resident, the following are the findings. It was reported that one resident had verbal exchanges with two other residents in the facility; and was threatened to poison food in this facility. Based on interviews, witnesses stated that there had been no reported incident of food poisoning in the facility. Meals served to the residents are directly served from the kitchen and only served or handled by dining hall or kitchen staff. Residents were never permitted to assist or share meals with other residents while in the dining hall and during meal service. Thus, the above allegation was UNFOUNDED.
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Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Luz Adams	TELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Albert Marin	TELEPHONE: (714) 309-7843
LICENSING EVALUATOR SIGNATURE:	DATE: 09/22/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2022

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-20211209161303

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: 09/22/2022

NARRATIVE

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On allegation that staff failed to meet resident's needs, the following are the findings. It was reported that resident experienced severe pain and was not given any medication to relieve the symptom. Resident was prescribed with as needed pain medication. Per interviews, Resident 1 did not disclose any need for pain medication nor any medication to manage other symptoms. Thus, the allegation was UNFOUNDED.

The Department has investigated the complaint alleging that staff failed to provide a safe environment for resident; and that staff failed to meet resident's needs. We have found that the complaint was unfounded, meaning that the allegations were false, could not have happened and/or are without a reasonable basis. We have therefore dismissed the complaint

LPA Marin conducted an exit interview with AD Glen Goldsmith and copy of this report was left in the facility.

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SUPERVISOR'S NAME: Luz Adams	TELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Albert Marin	TELEPHONE: (714) 309-7843
LICENSING EVALUATOR SIGNATURE:	DATE: 09/22/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2022

LIC9099 (FAS) - (06/04)

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