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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306000502
Report Date: 12/15/2021
Date Signed: 12/15/2021 02:43:05 PM

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: 63DATE:
12/15/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Administrator Glen Goldsmith TIME COMPLETED:
01:00 PM
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Licensing Program Analyst (LPA) Albert Marin made an unannounced required annual inspection in this facility. LPA met with Administrators(AD) Glen Goldsmith and stated the purpose of this visit.

The facility is a two level structure and licensed capacity of 120 of which 58 are non-ambulatory and on first floor only. Facility has hospice waiver for 18. For this visit, there were three residents under hospice care.

About 12:00 PM , LPA Marin was granted entry after completing the Coronavirus 2019 (COVID 19) screening procedure. LPA toured the interior and exterior portions of the facility with AD Goldsmith. LPA observed new sprinkler system in place in the common areas and residents rooms. Resident's rooms are generally shared and provided with private bathrooms. LPA inspected random rooms and observed to be provided with furniture in good repair, clean linens, adequate storage space, and kept free of tripping hazards. Smoke, and carbon monoxide alarms were observed to be in working conditions. Sprinkler and water system was tested last April 13, 2021. AD agreed to provide Community Care Licensing Division with copy of the latest fire alarm testing. Random call system were tested to be operational on both floors. Bathrooms were observed to be in good repair. Hot water was measured between 105 - 110 degrees Fahrenheit. Kitchen and dining area appeared in order and clutter free. LPA received a copy of December 2021 Dietitian Inspection with no immediate health and safety concerns. Facility met the minimum two day supply of perishable and seven day supply of non-perishable food stock requirements. Medications, cleaning supplies and sharp items were inaccessible to residents in care. Fire extinguishers were mounted and charged. For the exterior portion, facility had outside furniture in good repair; and grounds were free of tripping hazards. LPA observed the required poster and information requirements. LPA Marin reviewed the COVID 19 mitigation plan of the facility.

For this visit, the facility was observed to be in substantial compliance with Title 22 Division 6 of the California Code of Regulations.

LPA Marin conducted an exit interview with AD Glen 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: 12/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2021
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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