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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 455002744
Report Date: 01/23/2024
Date Signed: 01/23/2024 01:46:15 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/18/2024 and conducted by Evaluator Ivan Avila
COMPLAINT CONTROL NUMBER: 59-AS-20240118155917
FACILITY NAME:HORIZON ET AL, LLCFACILITY NUMBER:
455002744
ADMINISTRATOR:LAWSON, STEPHENFACILITY TYPE:
740
ADDRESS:1023 GREENBRIAR CTTELEPHONE:
(530) 227-5020
CITY:REDDINGSTATE: CAZIP CODE:
96003
CAPACITY:6CENSUS: 5DATE:
01/23/2024
UNANNOUNCEDTIME BEGAN:
12:40 PM
MET WITH:Josiah HendersonTIME COMPLETED:
02:10 PM
ALLEGATION(S):
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Resident locked in room
INVESTIGATION FINDINGS:
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On 01/23/2024, Licensing Program Analyst (LPA) Ivan Avila conducted an unannounced complaint investigation visit regarding the above allegation directed by the Department. LPA Avila met with staff member Josiah Henderson and explained the reason for the visit.
LPA toured R1s bedroom and observed two doorknobs that were covered. The covers for the doorknobs are ones that cover it and to open the doorknob there were a couple of places for the fingers to press that created pressure between the cover and the doorknob and the doorknob could open. R1 is diagnosed with dementia and can not open the door without assistance. The doorknobs that were covered are designated exits. Because it is a designated exit an immediate $500 civil penalty was issued. The doorknob covers were removed during visit.
Based on observation, the preponderance of evidence standard has been met, therefore the above allegation is found to be Substantiated. California Code of Regulations, Title 22, is being cited on the attached LIC 9099D. Appeal Rights provided.
Exit interview was conducted and copy of the report was provided..

Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Ivan Avila
LICENSING EVALUATOR SIGNATURE:

DATE: 01/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
Control Number 59-AS-20240118155917
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: HORIZON ET AL, LLC
FACILITY NUMBER: 455002744
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/23/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/24/2024
Section Cited
CCR
87203
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Fire Safety. All facilities shall be maintained in conformity with the regulations adopted by the State Fire Marshal for the protection of life and property against fire and panic. This requirement is not met as evidence by:
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By 02/24/2024 doorknob covers will be removed and a picture of the doorknobs will be emailed to LPA Avila.

***$500.00 Immediate Civil Penalties issued today.
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Based on observation of the doorknob being covered with a cover to prevent resident from getting out and it is a designated exit which poses an immediate Health and Safety, and Personal Rights risk to persons in care.
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*** Doorknob covered was removed during visit***
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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.
SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Ivan Avila
LICENSING EVALUATOR SIGNATURE:

DATE: 01/23/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3