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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006555
Report Date: 09/06/2024
Date Signed: 09/06/2024 12:06:07 PM

Document Has Been Signed on 09/06/2024 12:06 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:HORIZONS HOMEFACILITY NUMBER:
306006555
ADMINISTRATOR/
DIRECTOR:		WILSON, LELAND CFACILITY TYPE:
735
ADDRESS:613 W AMERIGE AVETELEPHONE:
(714) 504-3862
CITY:FULLERTONSTATE: CAZIP CODE:
92832
CAPACITY: 2CENSUS: 0DATE:
09/06/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
07:15 AM
MET WITH:Administrator, Leland WilsonTIME VISIT/
INSPECTION COMPLETED:
12:25 PM
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Licensing Program Analyst (LPA) Jenifer Tirre visited this facility for the purpose of conducting a Pre-Licensing evaluation. Facility is a single story residential home. LPA along with Administrator/ Licensee Leland Wilson toured facility at 7:30AM and observed the following:

Fire clearance approval was received on 05/09/24. Structure: Facility is a one story, 3 bedroom (2 Clients bedrooms and 1 live in staff bedroom) 2 bathroom house with work room unit for activities located behind house. Facility has no garage and a gray exterior. Living Room/ Dining Room: Adequate seating is available in the dining room and living room. Bedrooms Residents: All Client bedrooms meet Licensing requirements. Bathrooms: All Client bathrooms have a working toilet, wash basin, and bathtub/shower. Restroom has non-skid surface mats in the shower. Linens & Hygiene Supplies: Facility has adequate supply of linens and towels. Emergency Phone Numbers and Exit Plan: Facility has Emergency Plan posted on wall. Food Service: Facility has 2 day perishables as well as 7 day non-perishables in the pantry/ refrigerator, as well as emergency food and water supply. Smoke Detectors: Smoke detectors/ carbon monoxide detectors were tested operational. Fire extinguishers are mounted and charged. Facility has 2 extinguishers. Facility has sharps and toxins secured in storage area.. Water Temperature: Tested and recorded at 112.6 degrees F. in facility bathrooms. Reading Material Games, and Equipment:
facility has games, books and pet therapy Medications, First-Aid Kit & Book: Facility has first aid kit present at the facility. Facility has a secured location for medications and facility files. Backyard: LPA observed the facility perimeter is secured by wall on one side and Gate with lock on other side of facility. LPA observed shaded outdoor seating.

Administrator's Certificate observed on wall expiring 11/3/2026



CONTINUED ON 809C
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jenifer Tirre
LICENSING EVALUATOR SIGNATURE: DATE: 09/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/06/2024
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: HORIZONS HOME
FACILITY NUMBER: 306006555
VISIT DATE: 09/06/2024
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Licensee to address the following corrections by 9/20/2024:
  • Front porch railing needs to be secured in place
  • Audible alarms needed for exits and windows
  • Window in client 1 bedroom needs repair
  • floor heater between living room and hallway needs to be secured to wall
  • staff room needs lock on door
  • backyard furniture needs updated cushions
  • Backyard common areas need to be cleared of cobwebs
  • backyard aisle way needs floor to be leveled near crawl space
  • Grape vines wiring needs to be removed in backyard patio
  • backyard needs to cleared of clutter
  • Office work room needs to be cleared of unused furniture
  • Facility needs internet access device
  • self latch on driveway gate
  • lock on small storage unit
  • Department postings moved near entry way





The facility is not ready to be licensed. Licensee to contact LPA when corrections are complete.

Component III not conducted during visit and will be conducted on follow up visit

An exit interview was conducted with Licensee and a copy of this report was left at the facility.
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jenifer Tirre
LICENSING EVALUATOR SIGNATURE:

DATE: 09/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2024
LIC809 (FAS) - (06/04)
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