306000502-5-26-2021-22-AS-LADS-C3VRSB-20210611131628

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306000502
Report Date: 05/26/2021
Date Signed: 05/26/2021 02:16:50 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
01/29/2021 and conducted by Evaluator Albert Marin

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20210129114635

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:	05/26/2021
		UNANNOUNCED	TIME BEGAN:	11:33 AM
MET WITH:	Administrator Glen Goldsmith		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Facility staff prevent residents from leaving the facility.

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. LPA met with Administrator (AD) Glen Goldsmith and stated the purpose of this visit.

In January 29, 2021, The Department received a complaint with allegation that facility staff prevent residents from leaving the facility. Based on observation, interviews and file review, the following are the findings. In December 3, 2020, The California Department of Public Health issued a Regional Stay Home Order in relation to increasing Coronavirus 2019 cases. The facility posted information poster by facility exits stating that residents “are to remain in the facility and refrain from venturing out into the public. Failure to comply with Safer Home Order is a crime punishable by fine, imprisonment or both. (California Health & Safety Code Section 12029(sic); Orange County Health & Safety Code Section 120175.5(b).). Please remain within the facility to promote a health and safe environment.”
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Unsubstantiated

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: 05/26/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/26/2021

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-20210129114635

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: 05/26/2021

NARRATIVE

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Eight out of eight witnesses stated that the facility discouraged residents from going out of facility around December 2020 to January 2021, but this did not affect them. Residents were observed to be going in and out of the facility and documented by exit log maintained by the facility. Returning residents were advised to stay inside their room for observation.

The Department is unable to ascertain if the allegations 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. Thus, the allegation that the facility staff prevent residents from leaving the facility is deemed UNSUBSTANTIATED.

LPA Marin conducted an exit interview with AD 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: 05/26/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/26/2021

LIC9099 (FAS) - (06/04)

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