306004329-4-15-2024-22-AS-ARJR-D4CV2H-20240415160308

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 306004329
Report Date: 04/15/2024
Date Signed: 04/15/2024 04:03:14 PM

Document Has Been Signed on 04/15/2024 04:03 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:	NEW HORIZON BOARD AND CARE III		FACILITY NUMBER:	306004329
ADMINISTRATOR/ DIRECTOR:	IMELDA AGUILA		FACILITY TYPE:	740
ADDRESS:	5330 E. RURAL RIDGE CIRCLE		TELEPHONE:	(714) 998-7750
CITY:	ANAHEIM HILLS	STATE: CA	ZIP CODE:	92807
CAPACITY: 6		CENSUS: 5	DATE:	04/15/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	01:16 PM
MET WITH:	Mary Leano-Caregiver, Licensee-Virgilio Aguila		TIME VISIT/ INSPECTION COMPLETED:	04:17 PM

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Licensing Program Analyst (LPA) Alvaro Ramirez, Jr. conducted an unannounced visit for the Required 1 Year Inspection. LPA explained the purpose of today’s visit, and was greeted and granted entry by Staff Mary Leano. Leano notified facility Administrator (AD) Imelda Aguila about the visit. AD arrived shortly after.

For today’s visit, LPA observed a total of 5 residents in care and 2 staff members on duty.

LPA observed the Administrator's Certificate for facility AD Imelda Aguila which expires on 06/30/2025.

LPA Ramirez toured the interior and exterior portions of the facility with Leano. The facility is a single level structure and is licensed for 6 non-ambulatory residents, of which 5 may be on hospice and 0 bedridden. For this visit, there are a total of 5 residents in care. There are a total of 5 bedrooms, of which 4 are private resident rooms, and 1 private bedroom for staff. LPA Ramirez toured each bedroom in the facility and observed that bedrooms were provided with furniture in good repair, clean linens, adequate storage space, and kept free of tripping hazards. Smoke and carbon monoxide detector and auditory exit alarms were tested and operational. There are a total of 3 restrooms of which 1 is for staff and 2 are for residents. Restrooms were observed to be in good repair, toilets were operational, and grab bars and non-skid floor mats were provided. Water temperature tested between 107.1-109.0 degrees Fahrenheit.

Facility met the minimum two-day perishable and seven-day non-perishable food supplies. Sharp items and knives were locked and inaccessible to residents in care. Fire extinguisher were charged, mounted and one was located by the main entrance, one by the kitchen and one in the garage.

LPA Ramirez observed the emergency disaster and evacuation plan, which is posted by the kitchen hallway. Facility had back-up emergency food and water supply, located in the garage

CONTINUED ON LIC809-C...

SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Alvaro Ramirez Jr.
LICENSING EVALUATOR SIGNATURE:	DATE: 04/15/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2024

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
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: NEW HORIZON BOARD AND CARE III	FACILITY NUMBER: 306004329
	VISIT DATE: 04/15/2024

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LPA observed that First Aid Kit had all the required components. LPA observed that medications and toxins were locked and inaccessible to residents in care.

For the exterior portion, LPA Ramirez observed a shaded patio with furniture, and the grounds were free of any hazards. There is 1 gate in the backyard, which is self-closing and self-latching. No bodies of water were observed.

LPA reviewed five resident files and two staff files. LPA interviewed residents and staff present.

For today's visit no deficiencies were issued per Title 22 Division 6 of the California Code of Regulations.

An exit interview was conducted with facility representative.

A copy of this report was provided at the time of exit.

SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Alvaro Ramirez Jr.
LICENSING EVALUATOR SIGNATURE:	DATE: 04/15/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2024

LIC809 (FAS) - (06/04)

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