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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107209161
Report Date: 11/25/2024
Date Signed: 11/25/2024 02:19:19 PM

Document Has Been Signed on 11/25/2024 02:19 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
FRESNO RO, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME:NEW HORIZONS FRESNO, LLCFACILITY NUMBER:
107209161
ADMINISTRATOR/
DIRECTOR:		DE LA CUEVA, JOSE ANTONIOFACILITY TYPE:
740
ADDRESS:1693 S HELM AVETELEPHONE:
(559) 349-3922
CITY:FRESNOSTATE: CAZIP CODE:
93727
CAPACITY: 4CENSUS: 4DATE:
11/25/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:30 PM
MET WITH:Amber Rubio, Program DirectorTIME VISIT/
INSPECTION COMPLETED:
02:30 PM
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On 11/25/2024, Licensing Program Analyst (LPA) Rachel Bruce arrived unannounced at the facility for the purpose of conducting an annual inspection. LPA was met by Administrator Jose Antonio DeLaCueva and Amber Rubio, Program Director(PD). LPA explained the purpose of the visit and PD had no questions. AD left the facility to conduct business off site and the rest of the inspection and information was provided by PD.
LPA toured both the interior and exterior of the home. The home has 3 bedrooms, 2.5 bathrooms, laundry room, garage being utilized for storage, stocked secondary refrigerator and freezer. Locked chemicals are stored in garage cabinet. There is a desk for staff located in the garage as well as locked medication (Seconday storage for extra bubble packs). There is adequate living space and currently there are 4 residents, all ambulatory. LPA observed the bedrooms to be clean and orderly and all had appropriate furnishings meeting regulatory requirements. One bedroom is shared the rest are private. No residents were present at the time of the visit as they all participate in day programs, and all are CVRC clients.

In the resident bathrooms LPA tested water temperature which was found to be within regulations however in the master bathroom, the water pressure was weak and LPA was unable to test. Resident hygiene supplies were properly stored and secured in the laundry room.

Tour of the outside revealed no issues. Grounds are clean, self latching gate is functioning and there are no obstructions throughout the facility including outdoors. The pool has appropriate security gate. There were places to recreate and appropriate lawn toys were available and in good working order.

The kitchen was toured and observed to be in good repair with necessary items and appliances. Dishware and utensils sufficient for 4 residents observed. Sharps and knives were properly stored and were locked and inaccessible. LPA observed food supply and found that there was sufficient perishable items meeting the 2 day requirement and 7 days of non-perishable food available. Menu was current and developed with the clients input.
SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Rachel A Bruce
LICENSING EVALUATOR SIGNATURE: DATE: 11/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/25/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO RO, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME: NEW HORIZONS FRESNO, LLC
FACILITY NUMBER: 107209161
VISIT DATE: 11/25/2024
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Medication records were reviewed and found to be accurate and updated. Pill count was conducted and no errors found. Medications are centrally stored and locked in a cabinet located in the kitchen with secondary (overflow) stored in a locked cabinet located in the garage.

First aid kit located in kitchen and found to contain required items. Two fire extinguishers were present in the home, one in the kitchen (serviced in May 2024) and the second in the living room (serviced in February 2024). Smoke and carbon monoxide detectors tested and found to be operational.

LPA conducted review of 2 resident files. LPA found the files contained required documentation. Accounting for P&I funds was appropriate and up to date. Medical documentation appropriately filed and up to date. Required documentation was present including physician assessment and current Needs and Services plan.
LPA was unable to review staff files as Administrator left the premises with the key to the locked cabinet. LPA will return to complete Staff file review.

No citations were issued at this visit.

The following documents or information are to be mailed or faxed to licensing by December 15, 2024.
1.) Current Facility Staff Roster / Work Schedule form LIC500
2.) Current Register of Facility Clients/Residents form LIC9020
3.) Copy of current Administrator Certificate
4.) Copy of current LIC610E Emergency Disaster Plan for Residential Care Facilities for the Elderly


NOTE: LPA utilized LIC809 to record inspection. LPA was unable to utilize the Care Tools Program due to recording an attempted visit back 10/10/2024.

Exit interview was conducted and a copy of the signed report provided to Amber Rubio.
SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Rachel A Bruce
LICENSING EVALUATOR SIGNATURE:

DATE: 11/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/25/2024
LIC809 (FAS) - (06/04)
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