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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107209161
Report Date: 11/05/2021
Date Signed: 11/05/2021 02:46:30 PM

Document Has Been Signed on 11/05/2021 02:46 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, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME:NEW HORIZONS FRESNO, LLCFACILITY NUMBER:
107209161
ADMINISTRATOR:DE LA CUEVA, JOSE ANTONIOFACILITY TYPE:
740
ADDRESS:1693 S HELM AVETELEPHONE:
(559) 349-3922
CITY:FRESNOSTATE: CAZIP CODE:
93727
CAPACITY: 4CENSUS: 0DATE:
11/05/2021
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Jose Antonio De La Cueva, AdministratorTIME COMPLETED:
01:30 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 11/05/21, Licensing Program Analysts (LPAs) M. Yang and K. Kaur arrived announced to conduct a Pre-Licensing inspection. The facility is a 4 bedroom and 2 bathrooms home and fire clearance was granted for 2 ambulatory and 2 non-ambulatory for a total of 4. There are no residents present during this inspection.

LPA toured inside and outside of facility. No obstructions observed. Knives will be kept locked and secure in the kitchen cabinet. Dishware and utensils observed. Centrally stored medication observed in locked two kitchen cabinet. Chemicals observed in stored and locked in garage. First aid kit observed completed. LPAs observed an extra supply of bed linens and personal hygiene products.

One bedroom has sufficient furniture and lighting. Bathroom observed to have grab bars for use of toilets. Bathrooms have non-skid mat. LPAs observed the water heater not operating. LPAs unable to check water temperature. Facility set at comfortable temperature. Fire extinguisher was last serviced 09/28/21. Smoke and carbon monoxide combination detector tested and operational during inspection.

The following will need to be brought into compliance:
1. Grabbed bars in bathroom for use of shower
2. Furnished livingroom
3. Wood board removed from facility exit doors
5. Binds/ covering in livingroom and master bedroom windows
6. Hallway lightening
7. Operating water heater

Licensee will need to contact LPA once items are completed. LPA will need to return for a follow-up inspection. Comp III was conducted during today’s pre-licensing visit.

Exit interview conducted. Administrator was informed that as COVID-19 precautionary measure, this report was provided via email. Report signed on-site.
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Mai Yang
LICENSING EVALUATOR SIGNATURE: DATE: 11/05/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/05/2021
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 1