<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 371881540
Report Date: 05/09/2024
Date Signed: 05/09/2024 11:59:42 AM

Document Has Been Signed on 05/09/2024 11:59 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
RIVERSIDE, CA 92507
FACILITY NAME:NEW BEGINNINGS #1, LLCFACILITY NUMBER:
371881540
ADMINISTRATOR/
DIRECTOR:		SELBURN, SHANEFACILITY TYPE:
735
ADDRESS:1234 BELLVER CIRCLETELEPHONE:
(760) 586-1994
CITY:FALLBROOKSTATE: CAZIP CODE:
92028
CAPACITY: 6CENSUS: 0DATE:
05/09/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:33 AM
MET WITH:ADMINISTRATOR, SHANE SELBURNTIME VISIT/
INSPECTION COMPLETED:
12:08 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On May 09, 2024, Licensing Program Analyst (LPA), Venus Mixson arrived for a scheduled visit for the purpose of conducting a Pre-Licensing visit. LPA Mixson met with the Administrator, Shane Selburn introduced herself, and stated the purpose of the visit.

Physical Plant: The location is a single-story home located at 1234 Bellver Circle Fallbrook, CA. 92028, and has six bedrooms, two full bathrooms, a living room, dining room, and a kitchen, with a two-car garage. A backyard and front yard. The North County Fire Protection District approved this facility for six Ambulatory, zero-Non-Ambulatory, and zero Bedridden residents, on January 16, 2024. The home has a first aid kit and manual, the Administrator has received First Aid and CPR training, and the Administrator’s certificate is current.
Medications: LPA Mixson observed where medications are to be stored, locked, and inaccessible to the residents. The home is equipped with lights in the passages and stocked with emergency night lights throughout the home. The smoke and carbon monoxide detectors were observed and are operable. LPA Mixson observed the fire extinguishers, and they were charged and in the green. The cleaning supplies were locked and inaccessible, along with the sharp objects and the Administrator informed the LPA there are no firearms on the premises.
Bedrooms: The bedrooms were large enough to allow for easy passage between the beds, and other required items of furniture were present currently at the time of this inspection. Chair, nightstand, and sufficient lighting for future residents.
Kitchen/Food: The knives were locked, plenty of pots, pans, and other kitchen accessories. The facility has the required seven-day supply of non-perishable food items, and will supply the non-perishable upon receiving residents. LPA Mixson observed hygiene supplies for residents. There were no pesticides, poisons, or other toxic substances stored in any food storage or preparation area currently at the time of this inspection. (87555).
Records: There are confidential storage space for personnel records at the time of this visit. (87412).
Bathrooms: The bathrooms floors were clean and sanitary and free of odors, water and other appliances were operable, water temperature tested within regulations. There were at least one toilet and sink for each six persons to include residents, family, and personnel. (87307), and at least one bathtub/shower for each ten persons which includes residents, family and/or live-in personnel. (87307).
CONTINUATION ON NEXT PAGE
SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Venus Mixson
LICENSING EVALUATOR SIGNATURE: DATE: 05/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/09/2024
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
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: NEW BEGINNINGS #1, LLC
FACILITY NUMBER: 371881540
VISIT DATE: 05/09/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Administration: LPA Mixson observed emergency exiting plans and telephone numbers posted, Personal Rights, Complaint Poster, and other required documents were posted currently at the time of this visit, along with the current Administrators certification. The facility theft and loss program policy are posted, currently at the time of this inspection. (87218).
Activities: There are activity supplies and equipment, including access to daily newspapers, current magazines, and a variety of reading materials in the language of choice. There is an outdoor activity area equipped for outdoor use. (87219), there is a therapeutic area for relaxing and reflecting.
Miscellaneous: There is a first aid kit, including sterile dressings, bandages, thermometer, and other items as required by regulations, (87465). There are laundry supplies and equipment, including machine in good repair, and there is space for clean linen storage and a separate space for soiled linen,(87307). LPA Mixson observed emergency lighting supplies to include flashlights, and extra batteries, along with a vehicle used to transport residents and is operable and registered as stated by the Administrator at the time of this visit, (87303).
Inside/Outside: All doors, and passageways are clear of obstruction. There was one body of water on the premises, locked and gated. There was enough clean linen and hygiene items, and there was appropriate lighting in each room. LPA Mixson observed central heating and air conditioning systems, and they are operable. The Administrator dialed the land line phone number (760) 645-3442, and it was operable. Outside/Yards: Had shade and covering for shaded visits, and activities. There were no obstructions observed. The Licensee stated there were no firearms, and/or ammunition on the premises.
CAB 8.0 Pre-licensing / COMP III was Requested and approved.

An exit interview was conducted, a copy of this report was provided to the Administrator, Shane Selburn.

SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Venus Mixson
LICENSING EVALUATOR SIGNATURE:

DATE: 05/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2024
LIC809 (FAS) - (06/04)
Page: 2 of 2