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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306004128
Report Date: 03/24/2022
Date Signed: 03/24/2022 03:09:32 PM


Document Has Been Signed on 03/24/2022 03:09 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
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868



FACILITY NAME:COAST NEW HORIZONFACILITY NUMBER:
306004128
ADMINISTRATOR:MALIHE FAKHOURIFACILITY TYPE:
740
ADDRESS:824 PRESIDIO DRIVETELEPHONE:
(714) 668-5607
CITY:COSTA MESASTATE: CAZIP CODE:
92626
CAPACITY:6CENSUS: 3DATE:
03/24/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:25 PM
MET WITH:Malihe Fakhouri - AdministratorTIME COMPLETED:
03:25 PM
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Licensing Program Analyst (LPA) Patricia Velazquez conducted an unannounced visit to Coast New Horizon. The purpose of today's visit was to conduct a Required 1 Year inspection. LPA Velazquez was allowed entry into the facility and met with Administrator (AD) Malihe Fakhouri. Caregiver Janat Zamani was also present. The facility is licensed for 6 non-ambulatory residents. The facility has a Hospice waiver for 3 residents. There are currently 3 residents living in the facility. The last emergency disaster drill was conducted on January 16, 2022.

At 1:41 PM LPA Velazquez conducted a tour of the physical plant along with AD Fakhouri. The 1 story home consists of 5 resident bedrooms with 3 bathrooms. There is 1 staff bedroom with 1 staff bathroom. The staff bathroom is currently undergoing renovation. The facility also has a living room, dining area, and kitchen. LPA Velazquez observed the Complaint poster was approximately an 8 x 10 size and informed AD Fakhouri of the correct poster size. AD Fakhouri ordered the correct Complaint poster during this visit and provided LPA with proof of such. The 3 residents in the facility appeared well-groomed and well cared-for. The resident bedrooms had the required furnishings, bed linens, and closet/drawer space to accommodate each resident comfortably. LPA Velazquez observed half bed rails on the bed of one of the residents which AD Fakhouri verified. AD Fakhouri provided LPA with the resident's file and LPA observed a written physician order for the bed rails but it did not specify the need for the bed rails. AD Fakhouri will obtain an updated written physician order for the resident's bed rails and maintain it in the resident's file. Resident bathrooms were checked. Resident bath towels and personal hygiene supplies were adequately stocked. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure, showers were free of mold/mildew and a non-skid surface or mat was in place. LPA Velazquez tested the hot water temperature in the resident bathrooms and the temperature measured at 109.5 degrees Fahrenheit in the first bathroom and at 105.4 degrees Fahrenheit in the second bathroom and at 105.8 degrees in the third bathroom which AD Fakhouri verified.
SUPERVISOR'S NAME: Sheila SantosTELEPHONE: (713) 334-2062
LICENSING EVALUATOR NAME: Patricia VelazquezTELEPHONE: (949) 236-0556
LICENSING EVALUATOR SIGNATURE:
DATE: 03/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/24/2022
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: COAST NEW HORIZON
FACILITY NUMBER: 306004128
VISIT DATE: 03/24/2022
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LPA Velazquez inspected the kitchen along with AD Fakhouri. Perishable and non-perishable food supply was checked and adequately stocked at the time of the visit. The fire extinguisher was fully charged. The smoke and carbon monoxide detectors are hardwired were tested and found to be operational. Medications, toxins and sharps were locked and inaccessible to residents. The auditory alarms throughout the facility were in operating condition. First Aid kit was checked and found to be in order. The facility did not have a First Aid manual and AD Fakhouri will order an updated manual.

LPA Velazquez along with AD Fakhouri toured the outside grounds. There was shading and sufficient seating for residents. Walkways around the home were clear of hazards and the exit gates were operational. There were no security bars or weapons on the premises.

No resident or staff files were reviewed at the time of this visit. LPA Velazquez informed AD Fakhouri to ensure a written physician's order indicating the need for the bed rails is present in a resident's file pursuant to Title 22 Regulation Section 87608 Postural Supports. LPA also reviewed and provided a copy of Title 22 Regulation Section 87608 Postural Supports. AD Fakhouri acknowledged receiving a copy of said regulation.



There were no deficiencies issued during this Required 1 Year inspection. An exit interview was conducted with Administrator Malihe Fakhouri and a copy of this report was provided at the time of this visit.
SUPERVISOR'S NAME: Sheila SantosTELEPHONE: (713) 334-2062
LICENSING EVALUATOR NAME: Patricia VelazquezTELEPHONE: (949) 236-0556
LICENSING EVALUATOR SIGNATURE:

DATE: 03/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/24/2022
LIC809 (FAS) - (06/04)
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