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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700388
Report Date: 11/06/2023
Date Signed: 11/06/2023 04:19:26 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 11/06/2023 04:19 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, 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:
11/06/2023
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Sharon ManalangTIME COMPLETED:
04:40 PM
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Licensing Program Analyst (LPA) Christina Valerio arrived unannounced to the facility to conduct an annual required inspection. Due to technical difficulties with the system, the choice to pick Annual Required Visit was not an option. LPA Valerio clicked Case Management - Annual continuation; however, this visit will count towards the facility completing their annual inspection. LPA met with designated administrator Sharon Manalang, and explained the purpose of the visit.

LPA and facility staff toured the physical plant to ensure compliance with Title 22 regulations. LPA observed the common areas, resident bedrooms, resident bathrooms, garage, and exterior area. Resident bedrooms were observed to be clean and free from debris or odors. Common areas were observed to be fully furnished, clean, and organized. Bathrooms were equipped with skid mats, hand rails, soap, paper towels, and a trash can with a lid. The hot water was measured at 105.8*degrees F, which is within the required regulatory range of 105.0*F - 120.0*F. A fire extinguisher, carbon monoxide detector, and smoke alarms were observed to be fully charged and in working condition. The facility had a minimum of 2 days of perishable food items and 7 days of non-perishable food items with an emergency food/water supply. No emergency exits were obstructed. Residents were observed watching television and in their room. Staff were assisting residents with phone calls, activities, and preparing dinner. LPA spoke to staff and residents during the visit.

LPA spoke to residents and staff during the visit. LPA observed 3 resident files and 2 staff files. Resident files were complete and up to date. Staff files were complete and had required training/certifications.

Per California Code of Regulations (CCR) - Title 22, Division 6, Chapter 8, no deficiencies were observed during today's visit. An exit interview was held, and a copy of the report was provided to facility staff.
SUPERVISOR'S NAME: Stephen RichardsonTELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Christina ValerioTELEPHONE: 916-823-6323
LICENSING EVALUATOR SIGNATURE:
DATE: 11/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/06/2023
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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