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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 335530218
Report Date: 03/10/2025
Date Signed: 03/10/2025 10:49:54 AM

Document Has Been Signed on 03/10/2025 10:49 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
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507
FACILITY NAME:CALI HORIZON HOMEFACILITY NUMBER:
335530218
ADMINISTRATOR/
DIRECTOR:		CABALLERO, ABRAHAMFACILITY TYPE:
735
ADDRESS:505 NEWHALL DRTELEPHONE:
(310) 738-9621
CITY:CORONASTATE: CAZIP CODE:
92879
CAPACITY: 4CENSUS: 0DATE:
03/10/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Licensee/Administrator Norma HamudTIME VISIT/
INSPECTION COMPLETED:
11:00 AM
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On 03/10/2025 at 09:00 AM, Licensing Program Analyst (LPA) Melody Brown made an unannounced visit to the facility. The purpose of the visit was to conduct the required comprehensive annual inspection. LPA met with Licensee/Administrator Norma Hamud and was granted entry to the facility. At the time of the visit, there was one (1) staff present, and zero (0) client present. The facility has four (4) bedrooms and two (2) and a half bathrooms. There are four (4) client bedrooms, two (2) and a half client bathrooms, an office area in the garage, a kitchen, a living room, a dining area, a laundry room, a backyard, and an attached two car garage. The facility's vendorized by Inland Regional Center (IRC). LPA toured the interior and exterior areas of the facility for a general overall inspection, which included, but was not limited to the following:

Physical Plant: The facility currently has no clients in care. There are no obstructions to indoor and outdoor passageways. The facility is maintained at a comfortable temperature of 72 degrees Fahrenheit. LPA inspected future client bedrooms; they are equipped with required furniture such as: mattresses, night stands, storage space, and sufficient lighting; bathrooms were clean, however, LPA Brown was informed by Licensee/Administrator Hamud that there's no hot water available at the facility since 03/08/2025 as the gas water heater broke and they will purchase a new gas water heater today, 03/10/2025. Technical Violation will be issued. LPA observed sufficient furniture throughout the facility. The facility is equipped with operating combined smoke detectors and carbon monoxide alarms. Posters such as personal rights, the Community Care Licensing Division (CCLD) complaint poster, and the Emergency Disaster plan, House Rules were posted in a common area. Cleaning supplies, toxins, sharps, and other dangerous items were kept inaccessible. There was a designated storage space for client/staff files. LPA observed empty medication closet where medication will be potentially stored and inaccessible to clients. Overall, the facility is clean and operating in safe conditions.

*** Continuation in LIC809C ***

SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Melody Brown
LICENSING EVALUATOR SIGNATURE: DATE: 03/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/10/2025
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
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507
FACILITY NAME: CALI HORIZON HOME
FACILITY NUMBER: 335530218
VISIT DATE: 03/10/2025
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Food Service: Licensee/Administrator Hamud informed LPA that they will have more than seven (7) days non-perishable food supply and two (2) days perishable food supply once they have clients in care. Dishes, cups, and utensils were also stored properly.

Care & Supervision: Facility currently has no clients in care. Licensee/Administrators at the facility have criminal record clearance, Medical Assessment, First Aid/CPR Certification and updated Administrator Certification through the Department.

Records Review: LPA observed the facility have updated Liability Insurance, Workers Compensation Insurance, and Surety Bond. However, LPA Brown noted that Licensee/Administrator Hamud did not develop the required Infection Control Plan. Technical Violation will be issued. Also, LPA Brown reviewed one (1) staff files for First Aid/CPR certification, criminal record clearance, and health screenings. File reviewed were complete. Medications and Personal and Incidentals (P&I) were not audited as the facility currently has no clients.

Moreover, LPA Brown observed that the facility has emergency supplies, food and water.

Based on the observations made during today’s visit, Three (3) Technical Violations were cited per Title 22, Division 6, of the California Code of Regulations (CCR).

An exit interview was conducted, and this report (LIC809), LIC9102 were discussed and provided to Licensee/Administrator Norma Hamud.

SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Melody Brown
LICENSING EVALUATOR SIGNATURE:

DATE: 03/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2025
LIC809 (FAS) - (06/04)
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