306000502-5-19-2021-22-AS-SSAS-C3RVAG-20210607161554

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306000502
Report Date: 05/19/2021
Date Signed: 05/19/2021 01:51:21 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
01/11/2021 and conducted by Evaluator James August

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20210111154217

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: 70	DATE:	05/19/2021
		UNANNOUNCED	TIME BEGAN:	01:45 PM
MET WITH:	Glen Goldmsith, Executive Director		TIME COMPLETED:	02:05 PM

ALLEGATION(S):

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Staff are not safeguarding a resident's property
Resident's room is in disrepair

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jim August made an unannounced visit to conclude a complaint investigation. LPA identified himself and discussed the purpose of the visit with Executive Director (E.D.) Glen Goldsmith.
The initial 10-day facility visit was completed on January 14, 2021.

The investigation into the allegation that residents room is in disrepair and staff are not safeguarding resident’s property revealed the following:

On January 14, 2021 LPA August interviewed E.D. Goldsmith who stated that resident 2 (R2) notified him on January 13, 2021 about a patio screen door with a tear in it as well as a broken locking mechanism on the room door. Goldsmith had the screen door and door lock repaired on January 15, 2021. R2 informed Goldsmith that resident 1 (R1) had been wandering into her room and took food, however offered no evidence of what was taken. Continued on LIC9099C....

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 703-2857
LICENSING EVALUATOR NAME: James August	TELEPHONE: 714-703-2853
LICENSING EVALUATOR SIGNATURE:	DATE: 05/19/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/19/2021

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-20210111154217

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: 05/19/2021

NARRATIVE

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On January 29, 2021, LPA August interviewed R2 who stated that her patio screen door, and door lock were in need of repairs and confirmed that upon notifying Goldsmith of the issues that they were resolved. R2 was not sure how long it took Goldsmith to perform the repairs but stated the repairs were completed about a week after Goldsmith was notified. R2 stated that R1 would wander into her room and feels that things were missing such as various food items but could not specifically identify what or how much was taken.

On May 4, 2021 LPA August interviewed resident 3 (R3). R3 stated that R1 would wander the hallway of resident rooms and try and open each door. R3 would find R1 in his room 3 to 4 times a week for several months. R3 stated that nothing in his room was taken and his room was in good repair.

As such, there is insufficient evidence to corroborate whether the above allegations have occurred. With the information obtained through the means described above, we have found the above allegations unsubstantiated. Although the allegations may have happened or may be valid; there is not a preponderance of evidence to prove that the alleged violations occurred.

An exit interview was conducted with E.D. Goldsmith and a copy of this report was provided.

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 703-2857
LICENSING EVALUATOR NAME: James August	TELEPHONE: 714-703-2853
LICENSING EVALUATOR SIGNATURE:	DATE: 05/19/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/19/2021

LIC9099 (FAS) - (06/04)

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