306000502-2-21-2025-22-AS-SSAS-DEC3A8-20250228170417

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306000502
Report Date: 02/21/2025
Date Signed: 02/21/2025 02:09:12 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 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
07/08/2021 and conducted by Evaluator Kevin Saborit-Guasch

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20210708134637

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: 77	DATE:	02/21/2025
		UNANNOUNCED	TIME BEGAN:	09:07 AM
MET WITH:	Glen Goldsmith, administrator		TIME COMPLETED:	11:00 AM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff caused injury to resident
Staff handle resident in a rough manner
Staff failed to provide adequate transportation for resident(s)

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

On this day, Licensing Program Analyst (LPA) Kevin Saborit-Guasch made an unannounced visit to the facility for the purpose of following up on the investigation of the three allegations listed above. LPA was greeted and granted entry by facility front desk staff after introducing himself and stating the purpose of the visit. Administrator Glenn Goldsmith was present to assist with the visit and was presented with the allegations investigated.

An initial investigation visit was conducted on July 16, 2021. During the visit, licensing staff conducted a tour of the interior and exterior portions of the facility and two resident and one staff interviews along with a review of resident records maintained at the facility. Additional records reviewed during the investigation.

During the present visit, LPA requested and obtained the facility's current census and reviewed records for resident R1.
CONTINUED ON FORM LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch	TELEPHONE: (714) 497-8754
LICENSING EVALUATOR SIGNATURE:	DATE: 02/21/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2025

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 2

Control Number 22-AS-20210708134637

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: NEW HORIZON LODGE, INC.	FACILITY NUMBER: 306000502
	VISIT DATE: 02/21/2025

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

CONTINUED FROM FORM LIC9099
Resident R1 was admitted to the facility on July 14, 2020 from a skilled nursing facility, on the assisted living waiver. R1 had a primary diagnosis of muscular distrophy and was non-ambulatory and requiring the use of a Hoyer lift to assist with transfers and toileting care. R1 was admitted on hospice on June 3, 2021, changed hospice provider on July 28, 2021, was discharged from hospice and readmitted with a third provider on June 14, 2022. Per a death report submitted by the facility to the Department, R1 passed away using medical aid in dying at the facility on July 29, 2022.

Regarding the allegation that Staff caused injury to resident, the following has been concluded: Based on interviews conducted and records reviewed, R1 required two-person assistance along with the use of a Hoyer lift to transfer from the bed to her wheelchair as well as to receive toileting care. At the time of the incident reported, R1 was admitted onto hospice care and receiving assistance from a hospice bath aide three times a week. Per a review of hospice records, there were recorded instances of lower limb and feet swelling as well as one instance of toe debridement being required. There is however no evidence that the injuries were related to negligence on behalf of staff members.

Regarding the allegation that Staff handle resident in a rough manner, the following has been concluded: Based on records reviewed and interviews conducted, the complexity of transfers for resident R1 was evidenced, however there was insufficient proof corroborating the allegation. Other concerns reported by R1 to hospice staff and local law enforcement also failed to yield any corroborating evidence.

Regarding the allegation that Staff failed to provide adequate transportation for resident(s), the following has been concluded: Due to R1's specific needs, the facility courtesy van could not be utilized, however transportation alternatives in the form of vouchers were provided to alleviate worries of cost expressed by the resident.

Based on the present investigation, the three allegations are found to be Unsubstantiated, meaning that although the above allegations may have happened there is not a preponderance of evidence to prove the alleged violations occurred.

An exit interview was conducted and a copy of this report was provided to a facility representative.

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch	TELEPHONE: (714) 497-8754
LICENSING EVALUATOR SIGNATURE:	DATE: 02/21/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 2