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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331800150
Report Date: 11/26/2024
Date Signed: 11/26/2024 03:23:36 PM

Document Has Been Signed on 11/26/2024 03:23 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, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507
FACILITY NAME:NEW HORIZONSFACILITY NUMBER:
331800150
ADMINISTRATOR/
DIRECTOR:		PEREZ, MA TERESA VFACILITY TYPE:
740
ADDRESS:7550 RUDELL ROADTELEPHONE:
(951) 531-8048
CITY:CORONASTATE: CAZIP CODE:
92881
CAPACITY: 15CENSUS: 15DATE:
11/26/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:30 PM
MET WITH:House Manager Eldalin De Deugd TIME VISIT/
INSPECTION COMPLETED:
03:30 PM
NARRATIVE
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On 11/26/2024 at 01:30 PM, Licensing Program Analyst (LPA) Melody Brown conducted an unannounced visit to the facility to commence a case management visit. LPA Brown was greeted and granted entrance by a staff member and LPA Brown met with House Manager Eldalin De Deugd. At the time of the visit, there were fifteen (15) residents, and five (5) staffs present.

During today's visit, LPA Brown observed Staff #10 (S10) working at the facility and per documents review, LPA Brown noticed that S10 has criminal background clearance but S10 criminal background clearance was not transferred to the facility prior to S10 employment. Also, staff interview and records review indicated that S10 started working at the facility on 01/2024 and S10 reported to LPA Brown that S10 worked at the facility for 75 days. House Manager De Deugd was informed that deficiency will be issued. Also, per records review, the facility was cited for the same violation 87411 Personnel Requirements(g)(2) on 07/15/2024 which is within the 12-month period. Therefore, a Civil Penalty will be assessed with the amount of $3000.00 and will continue to be assessed of $100.00 per day per citation until corrected for not transferring S10 criminal background clearance to the facility prior to employment.

An exit interview was conducted where this report (LIC809), LIC809D, LIC421BG and Appeal Rights were discussed and provided to House Manager Eldalin De Deugd.

SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Melody Brown
LICENSING EVALUATOR SIGNATURE: DATE: 11/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/26/2024
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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Document Has Been Signed on 11/26/2024 03:23 PM - It Cannot Be Edited


Created By: Melody Brown On 11/26/2024 at 02:29 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507

FACILITY NAME: NEW HORIZONS
FACILITY NUMBER: 331800150

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/26/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type B
12/06/2024
Section Cited
CCR
87411(g)(2)

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87411 Personnel Requirements - General (g) Prior to employment or initial presence in the facility, all employees and volunteers subject to a criminal record review shall: (2) Request a transfer of a criminal record clearance as specified in Section 87355(c) or
This requirement is not met as eveidenced by:
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Licensee stated to transfer S10 Criminal Background Clerance to the facility or submit a Criminal Background Clearance Transfer Request form (LIC9182) for S10 and submit proof to LPA Brown on Plan of Correction (POC) due date.
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Based on observation, interview, record review, the licensee did not comply with the section cited above by not transferring Staff #10 (S10) criminal backgound clearance to the facility prior to employment which pose potential health, safety and personal rights risks to residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Efren Malagon
LICENSING EVALUATOR NAME:Melody Brown
LICENSING EVALUATOR SIGNATURE:
DATE: 11/26/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/26/2024


LIC809 (FAS) - (06/04)
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