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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 371881469
Report Date: 09/11/2024
Date Signed: 09/11/2024 11:56:07 AM

Document Has Been Signed on 09/11/2024 11:56 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
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:NEW BEGINNINGS #1, LLCFACILITY NUMBER:
371881469
ADMINISTRATOR/
DIRECTOR:		SELBURN, SHANEFACILITY TYPE:
735
ADDRESS:1109 BELAIR DRIVETELEPHONE:
(760) 645-3052
CITY:FALLBROOKSTATE: CAZIP CODE:
92028
CAPACITY: 6CENSUS: 6DATE:
09/11/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:45 AM
MET WITH:Licensee, Shane SelburnTIME VISIT/
INSPECTION COMPLETED:
12:00 PM
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On 9/11/2024, Licensing Program Analysts (LPAs) Janette Romero and Debbie Palacios made an unannounced visit to the facility to conduct a required annual inspection. LPAs were greeted and granted entry by House Manager (HM), Vinnie Cordova who was informed of the purpose of the visit. Licensee, Shane Selburn and HM, Hans Laske arrived during the visit. Licensee Selburn informed LPAs that all clients were attending day program. The facility has a fire clearance for six (6) ambulatory clients and serves adults ages 18 through 59.

LPAs toured the facility and reviewed records. During the tour, LPAs observed the facility is made up of a one (1) story home with six (6) client bedrooms, two (2) bathrooms, a living room, dining room and office/laundry room. All client bedrooms had the required furniture and lighting. LPAs toured the facility's exterior and observed outdoor pathways were free of obstructions. Outdoor shaded seating area is available for the clients in care. LPAs observed a hallway cabinet filled with clean towels, blankets, and linen, available for the clients. LPAs toured the kitchen and observed the facility has a 2-day supply of perishable foods and more than a 7-day supply of non-perishable foods, which are stored in a safe and healthful manner. LPAs observed knives and sharp instruments secured in locked kitchen cabinets. Cleaning solutions and disinfectants are secured in a locked laundry room cabinet. HM Laske tested one (1) of the smoke alarms/carbon monoxide detectors and LPAs observed it to be operational. LPAs also observed three (3) charged fire extinguishers mounted throughout the facility. Medications are secured in a locked cabinet stored in the office.
SUPERVISORS NAME: Tricia Danielson
LICENSING EVALUATOR NAME: Janette Romero
LICENSING EVALUATOR SIGNATURE: DATE: 09/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/11/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: NEW BEGINNINGS #1, LLC
FACILITY NUMBER: 371881469
VISIT DATE: 09/11/2024
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LPAs reviewed the Medication Administration Record along with the physical medications for three (3) clients and did not discover any discrepancies. LPAs reviewed random client files and observed clients had updated Individual Program Plans and signed admission agreements. The facility conducts four (4) emergency disaster drills each month. LPAs reviewed the facility's Fire and Training Earthquake Log for August and September 2024 and the facility's last fire drill was conducted on 09/06/24 and earthquake drill on 08/30/24. LPAs reviewed the Record of Client's/Resident's Safeguarded Cash Resources (LIC 405) and Licensee Selburn and HM Laske reviewed the physical monies for three (3) clients, and no discrepancies were discovered. Exit signs, emergency contact information, client's personal rights, and complaint information are visibly posted near the front entrance.

During today's visit, LPAs did not observe any issues or concerns. An exit interview was conducted and a copy of this report was reviewed and provided to Licensee Selburn.
SUPERVISORS NAME: Tricia Danielson
LICENSING EVALUATOR NAME: Janette Romero
LICENSING EVALUATOR SIGNATURE:

DATE: 09/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2024
LIC809 (FAS) - (06/04)
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