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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 275202200
Report Date: 04/14/2023
Date Signed: 07/12/2023 04:10:26 PM


Document Has Been Signed on 07/12/2023 04:10 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
FRESNO ASC, 1314 E SHAW AVE
FRESNO, CA 93710



FACILITY NAME:NEW HORIZON #2FACILITY NUMBER:
275202200
ADMINISTRATOR:JOSE MARI VITANFACILITY TYPE:
735
ADDRESS:73 PALOMA AVE.TELEPHONE:
(831) 758-2139
CITY:SALINASSTATE: CAZIP CODE:
93905
CAPACITY:25CENSUS: 24DATE:
04/14/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Licensee, Benjamin MacasaetTIME COMPLETED:
02:00 PM
NARRATIVE
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Licensing Program Analyst (LPA) Sarah Hurt conducted an unannounced visit today to conduct a Case -Management visit. LPA Hurt met with Licensee, Benjamin Macasaet and explained the purpose of today's visit.

LPA Hurt reviewed a letter signed by facility Administrator Jose Vitan addressed to Resident 1, dated March 28, 2023, Re: Eviction Notice.


The letter is a 30 day eviction notice for Resident 1 due to "violating the behavioral health contract" signed on 10/14/2020. The facility did not notify Licensing of this eviction notice given to Resident 1.


The following deficiencies are being cited per Title 22 Regulations.

Exit interview conducted, and a copy of this report provided.
SUPERVISOR'S NAME: Brenda ChanTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Sarah HurtTELEPHONE: 559-243-8080
LICENSING EVALUATOR SIGNATURE:
DATE: 04/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/14/2023
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


Document Has Been Signed on 07/12/2023 04:10 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SIERRA CASCADE AC/SC, 1314 E SHAW AVE
FRESNO, CA 93710


FACILITY NAME: NEW HORIZON #2
FACILITY NUMBER: 275202200

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/14/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/28/2023
Section Cited
CCR
85068.5(e)

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85068.5 Eviction Procedures
(e) A written report of any eviction processed in accordance with (a) above shall be sent to the licensing agency within five days of the eviction. The following requirement has not been met as evidenced by:
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Administrator will conduct training with facility staff on reporting requirements and send proof to LPA Hurt by 04/28/2023.
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The facility Administrator did not notify Licensing of the eviction notice given to Resident 1, which poses a potential, health, safety or personal rights risk to residents in care.
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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: Brenda ChanTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Sarah HurtTELEPHONE: 559-243-8080
LICENSING EVALUATOR SIGNATURE:
DATE: 04/14/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/14/2023
LIC809 (FAS) - (06/04)
Page: 2 of 2