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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306000502
Report Date: 07/16/2021
Date Signed: 07/16/2021 11:37:01 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		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
ADMINISTRATOR:GLEN E GOLDSMITHFACILITY TYPE:
740
ADDRESS:8541 CERRITOS AVENUETELEPHONE:
(714) 821-5781
CITY:STANTONSTATE: CAZIP CODE:
90680
CAPACITY:120CENSUS: 67DATE:
07/16/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Administrator Glen Goldsmith TIME COMPLETED:
10:00 AM
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Licensing Program Analyst (LPA) Albert Marin made an unannounced visit to this facility to conduct a case management visit for an incident. LPA met with Administrator (AD)_ Glen Goldsmith and stated the purpose of this visit.

On July 1, 2021, Community Care Licensing Division (CCLD) received a verbal report from AD Goldsmith about Resident 1 who was tested positive for banned substance during a random routine blood testing conducted outside the facility. On July 9, 2021, CCLD received the written report.

About 9:31 AM, LPA Marin conducted interview and file review. AD Goldsmith discussed the progress and the current status of the resident, with no further untoward incident.

For this visit, no citation was issued at this time.

LPA Marin conducted an exit interview with AD Goldsmith and copy of this report was left in the facility.
SUPERVISOR'S NAME: Luz AdamsTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Albert MarinTELEPHONE: (714) 309-7843
LICENSING EVALUATOR SIGNATURE:

DATE: 07/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
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