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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700388
Report Date: 10/21/2022
Date Signed: 10/21/2022 10:02:25 AM


Document Has Been Signed on 10/21/2022 10:02 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, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833



FACILITY NAME:NEW HORIZON BOARD AND CARE IIFACILITY NUMBER:
342700388
ADMINISTRATOR:PEREZ, SUSANA GFACILITY TYPE:
740
ADDRESS:10051 SHANA WAYTELEPHONE:
(916) 585-9460
CITY:ELK GROVESTATE: CAZIP CODE:
95757
CAPACITY:6CENSUS: 3DATE:
10/21/2022
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
09:05 AM
MET WITH:Sharon PerezTIME COMPLETED:
10:15 AM
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On 10/21/2022 at 9:05 am, Licensing Program Analyst (LPA) Tung Truong arrived at this facility unannounced to conduct a proof of correction (POC) visit in regard to deficiencies cited on 10/11/2022. LPA met with Assistant Administrator Sharon Perez and stated the purpose of today’s visit.

LPA observed water temperature in the kitchen is 118.9 degrees Fahrenheit and bathroom sink is 117.6 degrees Fahrenheit.

*Deficiency cited under Title 22 Regulation 87303(e)(2) – Cleared. Proof of correction was submitted on 10/12/2022. Licensee complied with the terms of the POC by POC due date.

Facility was provided POC cleared letter.

Exit interview conducted and a copy of this report provided.
SUPERVISOR'S NAME: Czarrina A Camilon-LeeTELEPHONE: (916) 263-4723
LICENSING EVALUATOR NAME: Tung TruongTELEPHONE: (916) 201-7895
LICENSING EVALUATOR SIGNATURE:
DATE: 10/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/21/2022
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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