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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306004330
Report Date: 07/26/2024
Date Signed: 07/26/2024 11:30:20 AM


Document Has Been Signed on 07/26/2024 11:30 AM - 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 IVFACILITY NUMBER:
306004330
ADMINISTRATOR:IMELDA AGUILAFACILITY TYPE:
740
ADDRESS:207 ISLANDIA DRIVETELEPHONE:
(714) 854-7568
CITY:PLACENTIASTATE: CAZIP CODE:
92870
CAPACITY:6CENSUS: 6DATE:
07/26/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:35 AM
MET WITH:Licensee, Imelda AguilaTIME COMPLETED:
11:35 AM
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On 7/26/2024, Licensing Program Analyst (LPA) Janette Romero conducted an unannounced visit to the facility for a required annual inspection. LPA was greeted and granted entry by Caregiver, Evangeline Javier who was informed of the purpose of the visit. Licensee, Imelda Aguila arrived during the visit and was also informed of the purpose of LPA's visit. The facility has a fire clearance for six (6) non-ambulatory elderly residents and an approved hospice waiver for five (5).

LPA toured the facility with Caregiver Javier and observed the facility is made up of a one-story home with five (5) resident bedrooms, three (3) bathrooms, a staff room, kitchen, dining room, living room, and attached garage. During the tour, facility staff tested one (1) of the smoke alarm/carbon monoxide detectors and LPA observed it to be operational. LPA also observed charged fire extinguishers mounted throughout the facility, serviced on 7/22/2024. Indoor and outdoor passageways were free of obstruction. The facility has an outdoor shaded seating area for the residents in care. There were no bodies of water observed on the premises. A brick wall secured the entire backyard. LPA toured the kitchen and observed food was stored in a safe and healthful manner. The facility had more than a 2-day supply of perishable foods and 7-day supply of non-perishable food items. Medications are stored in a locked kitchen cabinet. Resident bedrooms had the required furniture and lighting. Resident bathrooms had grab bars near the toilets and in the showers. The facility also has additional clean linens and towels different hallway cabinets. Additional non-perishable food is stored in the garage. LPA reviewed random staff and resident files. Resident files reviewed had updated physician's reports and signed admission agreements. Staff present had a criminal record clearance and a valid first aid/CPR certification.

During today's visit, LPA did not observe any issues or concerns. An exit interview was conducted where this report was reviewed and provided to Licensee Aguila.

SUPERVISOR'S NAME: Tricia DanielsonTELEPHONE: (951) 202-5067
LICENSING EVALUATOR NAME: Janette RomeroTELEPHONE: 951-248-0350
LICENSING EVALUATOR SIGNATURE:
DATE: 07/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/26/2024
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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