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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005311
Report Date: 07/26/2021
Date Signed: 07/27/2021 08:36:09 AM

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 BOARD AND CARE VIIFACILITY NUMBER:
306005311
ADMINISTRATOR:AGUILA, VIRGILIOFACILITY TYPE:
740
ADDRESS:1397 ARROWHEAD DRIVETELEPHONE:
(714) 742-5313
CITY:PLACENTIASTATE: CAZIP CODE:
92870
CAPACITY:6CENSUS: 4DATE:
07/26/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Staff Blenda Bautista and Rina Matibag and Licensee Imelda AguilaTIME COMPLETED:
11:00 AM
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Licensing Program Analyst (LPA) Michelle Reed made an unannounced visit to the facility to conduct an Annual visit. Upon arrival LPA met with Staff Blenda Bautista and Rina Matibag. LPA explained the purpose of the visit. Licensee Imelda Aguila arrived shortly after LPA.

During the visit LPA toured the facility inside and out with Blenda Bautista. LPA observed Covid signage at front entrance of facility as well as a sanitization station. Facility has required Department postings. LPA toured all resident rooms. Rooms were clean and sanitary. All restrooms observed contained ample supplies of paper towels and soap. Hand sanitizer, wipes and gloves were also present.

LPA observed outside visitation area with ample shading. Three residents were in their rooms resting and one was watching tv. Licensee has required Mitigation plan and Emergency Disaster Plan. Emergency food and water supply were also present. Facility has a secured location for resident medication and files.

During the visit, LPA consulted with staff regarding the importance of maintaining a 30 day supply of PPE on site. Additionally, LPA discussed sign in and screening procedures for visitors. LPA advised the importance of mask wearing and handwashing for staff at all times.

No deficiencies observed during visit. An exit interview was conducted with and a copy of this report was provided to Imelda Aguila.

SUPERVISOR'S NAME: Sheila SantosTELEPHONE: (714) 703-2857
LICENSING EVALUATOR NAME: Michelle ReedTELEPHONE: (714) 743-4958
LICENSING EVALUATOR SIGNATURE:

DATE: 07/26/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2021
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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