306004128-2-20-2025-22-AS-JCHO-DE3SNN-20250220130150

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 306004128
Report Date: 02/20/2025
Date Signed: 02/20/2025 01:02:07 PM

Document Has Been Signed on 02/20/2025 01:02 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

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

FACILITY NAME:	COAST NEW HORIZON		FACILITY NUMBER:	306004128
ADMINISTRATOR/ DIRECTOR:	MALIHE FAKHOURI		FACILITY TYPE:	740
ADDRESS:	824 PRESIDIO DRIVE		TELEPHONE:	(714) 668-5607
CITY:	COSTA MESA	STATE: CA	ZIP CODE:	92626
CAPACITY: 6	TOTAL ENROLLED CHILDREN: 0	CENSUS: 2	DATE:	02/20/2025
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	08:05 AM
MET WITH:	Malihe Fakhfouri- Administrator		TIME VISIT/ INSPECTION COMPLETED:	01:20 PM

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	Licensing Program Analyst (LPA) Jessica Cho arrived at the facility unannounced for the purpose of conducting the Required 1-Year annual evaluation. LPA was greeted and granted entry by Administrator (Admin) Malihe Fakhfouri and explained the reason for the visit. Administrator Fakhfouri had a valid certificate expired on July 3, 2024. LPA reviewed the certificate of completion and all course work were completed on April 30 and May 1, 2024. The facility is a single story structure located in a residential neighborhood. Facility is licensed to operate for six bedridden residents and maintains a hospice waiver for two residents. There are two residents in care and the Admin on duty. There are five resident bedrooms and three resident bathrooms. There is one additional private bedroom and bathroom for the live-in Admin. All common areas were inspected including the the attached two car garage. The residents' bedrooms were appropriately furnished. Beds and bedding supplies were in good condition, adequate lighting was provided, sufficient storage space for each residents' personal belongings were observed. Bathrooms were found to be in compliance, clean, and operational. The hot water temperature measured at 106.7, 105.2, and 105.2 degrees Fahrenheit. Toxins, disinfectants, sharps, and medications were secured and inaccessible. LPA observed sufficient two-day supply of perishables and seven-day supply of non-perishable food available. The fireplace was screened. LPA toured the exterior portion of the facility. The outdoor passageway is free of obstruction. The exit gates were self-closing and self-latching. LPA observed sufficient seating and shading. The three fire extinguishers were purchased on February 5, 2025 per the purchase receipt. The auditory devices and dual functioning smoke/carbon monoxide detectors were tested and operational. LPA observed sufficient emergency food/water in the outdoor walk-in pantry room. Emergency evacuation drills are not conducted quarterly with the last drill on August 28, 2024. The first aid kit contains all necessary elements. The facility land line number, (714) 668-5607, was tested and remains available. The liability insurance is valid expiring on October 30, 2025. LPA observed the required 'See Something, Say Something' (PUB 475) posters in the incorrect size of 11" x 16."

Lourdes Montoya	TELEPHONE: (714) -70-2870
Jessica Cho	TELEPHONE: 714-703-2853
	DATE: 02/20/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2025

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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Document Has Been Signed on 02/20/2025 01:02 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: COAST NEW HORIZON	FACILITY NUMBER: 306004128
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/20/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Section Cited

HSC

1569.695(c)

(c) A facility shall conduct a drill at least quarterly for each shift. The type of emergency covered in a drill shall vary from quarter to quarter, taking into account different emergency scenarios. An actual evacuation of residents is not required during a drill. While a facility may provide an opportunity for residents to participate in a drill, it shall not require any resident participation. Documentation of the drills shall include the date, the type of emergency covered by the drill, and the names of staff participating in the drill. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, interview, and record review, the licensee did not comply with the section cited above which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 02/27/2025
	Plan of Correction
1 2 3 4	Administrator confirmed to conduct quarterly drills and will provide proof of drill to LPA via email by POC due date.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

Lourdes Montoya	TELEPHONE: (714) -70-2870
Jessica Cho	TELEPHONE: 714-703-2853
	DATE: 02/20/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2025

LIC809 (FAS) - (06/04)

Page: 2 of 6

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: COAST NEW HORIZON	FACILITY NUMBER: 306004128
	VISIT DATE: 02/20/2025

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The following items were addressed: discussed the importance of conducting and maintaining records of the quarterly disaster drills, to complete the current Emergency Disaster Plan (LIC610E) updated on (3/19), organize all personnel/resident records, to increase the PUB 475 poster in the size of 20" x 26," and to ensure annual fees in the amount of $495.00 is paid timely due March 17, 2025.

Based on the observations made during today's visit, a deficiency is being cited. Advisory Notes (LIC9102s) are also being issued.

An exit interview was conducted with Administrator Malihe Fakhfouri, and a copy of this report (LIC809/LIC809-C), LIC809-D, LIC9102s, appeal rights, and a copy of the LIC610E were provided at the end of the visit.

SUPERVISOR'S NAME: Lourdes Montoya	TELEPHONE: (714) -70-2870
LICENSING EVALUATOR NAME: Jessica Cho	TELEPHONE: 714-703-2853
LICENSING EVALUATOR SIGNATURE:	DATE: 02/20/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2025

LIC809 (FAS) - (06/04)

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