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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 392700577
Report Date: 04/24/2024
Date Signed: 04/24/2024 03:19:45 PM

Document Has Been Signed on 04/24/2024 03:19 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
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:HORIZON DAY PROGRAMFACILITY NUMBER:
392700577
ADMINISTRATOR/
DIRECTOR:		CHRISTOPHER YARRUHSFACILITY TYPE:
775
ADDRESS:2200 N EL DORADO STTELEPHONE:
(209) 932-9199
CITY:STOCKTONSTATE: CAZIP CODE:
95204
CAPACITY: 60CENSUS: 37DATE:
04/24/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:11 PM
MET WITH:Georgen Dumpit Program ManagerTIME VISIT/
INSPECTION COMPLETED:
03:27 PM
NARRATIVE
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On 4/24/2024 Licensing Program Analyst (LPA) Albert Johnson conducted an unannounced Annual Inspection. LPA met with Georgen Dumpit and explained the purpose of the visit.

LPA and Program Manager(PM) toured the facility including but not limited too, activity rooms, a common area, kitchen area and facility bathrooms. LPA observed the rooms were clean, organized and in good repair. Hot water temperature measured at 119.6 degrees F. in bathroom. The facility provides snacks throughout the day for the clients. There are six restricted health care plans in place for clients at day program.

Fire drill was last conducted on April 03, 2024. The facility does administer medications currently for clients. The facility does not keep P& I monies for clients. Exits were observed to be accessible to clients and free from obstructions. LPA observed smoke alarms and carbon monoxide detectors interconnected with the fire department. Fire extinguishers were serviced and current for 2024. First aid kit observed to be complete. LPA reviewed 10 client and five staff records files. The program is vendored for transportation and is in compliance with R&D transportation.

During the review of medication with the PM and LVN it was observed that an outdated medication for R1 was given. The medication expired on 4/19/2024 and was administered on 4/22/24, 4/23/2024 and today

Based on today’s inspection, Per California Code of Regulations, Title 22 Division 6, Chapter 8, deficiencies were observed and cited today.

An exit interview was conducted and appeal rights given.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Albert Johnson
LICENSING EVALUATOR SIGNATURE: DATE: 04/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/24/2024
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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Document Has Been Signed on 04/24/2024 03:19 PM - It Cannot Be Edited


Created By: Albert Johnson On 04/24/2024 at 02:49 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: HORIZON DAY PROGRAM
FACILITY NUMBER: 392700577

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/24/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
82075(b)
Health related services

This requirement is not met as evidenced by: Records review and interviews conducted
Deficient Practice Statement
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LPA observed an expired medication at the facility: Program manager and LVN informed LPA that Residents home was contacted, however, the medication did not come and the facility used the expired medication for three days.
POC Due Date: 04/25/2024
Plan of Correction
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Med tech will receive an in service training regarding medication administration and expiration dates
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Lisa Rios
LICENSING EVALUATOR NAME:Albert Johnson
LICENSING EVALUATOR SIGNATURE:
DATE: 04/24/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/24/2024


LIC809 (FAS) - (06/04)
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