New Horizon Lodge

Type of visit: Case Management - Incident

This unannounced case management inspection is being conducted by Licensing Program Analyst (LPA) Sean Haddad for the purpose of following up on a self-reported incident report received in the Orange County Regional Office (OCRO) on 01/04/23 regarding a medication error involving Resident #1 (R1). LPA met with Administrator (AD) Glen Goldsmith and discussed the purpose of the inspection. The incident report states that on 12/31/22, R1 received the wrong medication at bedtime, facility staff notified a doctor who advised facility staff to monitor R1 and report any changes, R1 was monitored, and additional training will be conducted to avoid future medication errors. During today’s inspection, LPA conducted a health and safety check on R1, observed no health and safety issues, and observed R1 was in good health and good spirits. LPA inspected the medication room, observed it to be clean and organized, and observed no health and safety issues. LPA interviewed AD who confirmed the information in the incident report and provided the following information: the medication error involved R1 receiving their own medications at the wrong time; on that day, R1 received their AM medications in the morning but in the PM R1 was given the next day’s AM medications instead of their PM medications; the error was made by Staff #1 (S1); the facility notified the doctor and observed R1; there were no complications with R1 and the doctor did not recommend sending R1 to the hospital; and the facility is completely retraining S1. LPA reviewed training records showing that S1 began the retraining process on 01/05/23 and completed the process on 01/10/23. Based on the information obtained during today’s inspection, deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. See LIC809D. An exit interview was conducted and a copy of this report and appeal rights was discussed with and provided to facility representative.the state’s words, verbatim · CDSS document, Jan 13, 2023

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(a)(4) · Plan of correction due date: Jan 14, 2023

87465 Incidental Medical and Dental Care. (a) … (4) The licensee shall assist residents with self-administered medications as needed. This requirement was not met as evidenced by: Based on interview and documents, the licensee did not ensure R1 received assistance with self-administered medications, which poses an immediate health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Jan 13, 2023

Plan of correction: During the inspection, Licensee provided proof that the staff at issue was retrained. POC CLEARED.

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Jerome Haley made an unannounced visit for the purpose of conducting a Case Management visit regarding Unusual Incident Reports (LIC 624) sent to the regional office. Both incident report were received December 16, 2022. LPA interviewed Wellness Coordinator Alexsondra Carrillo and spoke with Administrator (AD) Glen Goldsmith via telephone regarding the incident reports. Regarding the first LIC 624 (incident date 12.14.22) LPA Haley received a copy of Resident 1's (R1) physicians report, and the information on R1's new dialysis center and the information the new transportation company taking R1 to his dialysis appointments. Regarding the second incident report (incident date 12.11.22) LPA Haley received copies of Resident 2s (R2): basic fact sheet, physicians report, and preplacement appraisal information. Further, LPA Haley reviewed the file for Staff 1 (S1) and received copies of the LIC 501 and a copy of Relias training completed by S1. No deficiencies are being cited as a result of today's visit. An exit interview was conducted and a copy of this report was provided.the state’s words, verbatim · CDSS document, Dec 27, 2022

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Jerome Haley arrived at the facility for the purpose of conducting a required one year infection control annual visit. LPA was greeted, granted entry by staff and explained the reason for the visit. Staff called the Administrator (AD) Glen Goldsmith who arrived and was present for the visit. AD Goldsmith has a current administrators certificate that expires 06/16/23. LPA Haley was pre screened and temperature checked upon entering the facility. There were 72 residents at the facility during the time of inspection The inspection began on the first floor of the facility. LPA Haley observed a locked medication room near the reception desk. LPA Haley observed mediation cart and two first aid kits with all the required items. The dining room and kitchen was clean and organized. LPA Haley observed a two day supply of perishable items and a seven day supply of nonperishable items in the kitchen. All knives and sharp objects were were safely stored. LPA observed a menu, and a list of residents on a special diet posted on the freezer next to the temperature logs. While touring the first floor of the facility, LPA observed the activities room and observed residents listening to music and exercising. A break room for facility staff was observed. LPA Haley tested the call light system and it tested operational. During the inspection of the second floor LPA observed the laundry room with plenty of clean linen. In the locked storage cabinets used to to store additional supplies of PPE: surgical mask, gowns, gloves, and N95 face mask were observed. On the second floor LPA Haley observed the maintenance room, and an additional activities room on the second floor for residents to enjoy. Continued on LIC809C While inspecting resident rooms on both floors, all resident rooms observed had the necessary requirements. Resident bathrooms were in good repair and the hot water temperature was measured between 105 - 112.3 degrees Fahrenheit. The exterior of the facility was clean and organized. Walkways were clear and free of tripping hazards. LPA observed several tables with plenty of sitting for the residents to enjoy while outdoors. No bodies of water observed. LPA observed several fully charged and mounted fire extinguishers mounted on the walls on both floors of the facility. No deficiencies are being cited as a result of todays visit. An exit interview was conducted and a copy of this report was provided to AD Goldsmith,.the state’s words, verbatim · CDSS document, Dec 20, 2022

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Jerome Haley conducted an unannounced case management visit at New Horizon Lodge. LPA was greeted, and explained the reason for the visit. LPA Haley met with Administrator (AD) Glen Goldsmith. The purpose of today's visit was to conduct a Case Management visit to discuss an Unusual Incident Report (LIC 624) that was sent to the Orange County Adult and Senior Care Program Regional Office October 6, 2022 that involved Resident 1 (R1). During the visit LPA Haley interviewed AD Goldsmith and R1 about the incident. LPA Haley received copies of R1's Physician's Report, Individualized Service Plan (ISP), and California Assisted Living Waiver ISP. Deficiencies are being cited during today's Case Management visit. An exit interview was conducted and a copy of this report, LIC809D, LIC811, and appeal rights were provided.the state’s words, verbatim · CDSS document, Oct 6, 2022

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87464(f)(1) · Plan of correction due date: Oct 6, 2022

Basic Services - (f) Basic services shall at a minimum include: (1)Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code section 1569.2(c) "Care and supervision" means the facility assumes responsibility for... ongoing assistance with activities of daily living without which the resident's physical health, mental health, safety, or welfare would be endangered. This requirement was not met as evidenced by: On 9/29/22 R1 left the facility without supervision and was gone for over an hour.This poses a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Oct 6, 2022

Plan of correction: Administrator agrees to train all residents on the use of the sign in/out sheet and reasses all residents curently unable to leave unassisted for accuracy. Proof of completion will be submitted to LPA Haley by Friday October 14, 2022.

Allegation investigated: Facility is not addressing residen'ts multiple falls.

Licensing Program Analyst (LPA) Jerome Haley made an unannounced visit to this facility to deliver findings on the complaint 22-AS-20220621171421. Upon entry, LPA Haley was explained the reason for the visit. Please see findings below: Regarding the allegation: Facility is not addressing residen'ts multiple falls. During the initial 10 day visit on 6/27/22,LPA Haley interviewed Resident 1 (R1) who confirmed staff at New Horizon Lodge assist him while ambulating around the facility and make sure he's using his cane or wheelchair. During that visit LPA Haley interviewed two caregivers who confirmed they assist R1 with various activities during the day. Interviews with Administrator Glen Goldsmith and Assistant Administrator Sarah Zarate, revealed that R1 was taken to the hospital after falling 5/4/22, 5/26/22, & 6/19/22. Interviews with AD Goldsmith revealed R1 was being seen by a Home Health Nurse, and his responsible party (RP) was made aware of R1's falls. Unsubstantiated Furthermore, Interviews with R1's RP revealed R1 was seen by a physician at the end of June, after his most recent fall at that time. It's unclear if the facility notified the RP after every fall or not. Based on the information gathered during the investigation, review of all documents obtained, the Department is unable to ascertain if the allegation occurred as reported. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove or refute the alleged violation occurred; therefore, this allegation is deemed Unsubstantiated.the state’s words, verbatim · CDSS document, Sep 27, 2022 · control 22-AS-20220621171421

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Jerome Haley made an unannounced visit to New Horizon Lodge, and was temperature checked upon entering the facility. LPA Haley met with Assistant Administrator Sarah Zarate and explained the reason for today's visit. During the investigation of complaint control #: 22-AS-20220621171421 it was discovered that Resident 1 (R1) did not have a current Physicians Report on file. The Physicians Report on file for R1 was dated May 1, 2017. Based on R1's Individualized Service Plan Dated June 25, 2022 and the Physicians Report dated May 1, 2017 R1's has had a change in condition. This change in condition has not been documented by a Physician on a LIC602A. During today's case management visit, deficiencies are being cited under California Code of Regulations, Title 22, Division 6, Chapter 8. An exit interview was conducted, a copy of this report, LIC809D, LIC811, and appeal rights was provided.the state’s words, verbatim · CDSS document, Sep 27, 2022

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87463(c) · Plan of correction due date: Sep 27, 2022

87463 Reappraisals (c) licensee shall arrange a meeting with the resident, the resident's representative... If any, whent there is significant change in the resident's condition, or once every 12 months, which ever occurs first, as specified in section 87467, Resident Participation in Decision Making. This requirement is not being met as evidenced by: During record review, LPA observed R1's Physicians Reported was dated May 1, 2017. This poses a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Sep 27, 2022

Plan of correction: Licensee agrees to review all resident files to ensure all records and reports are current. Licensee agrees to have this completed by POC due date: Friday October 7, 2022.

Allegation investigated: Facility charged resident for a service not received.

Licensing Program Analyst (LPA) Albert Marin made an unannounced visit to this facility to deliver the findings for the investigation completed for the complaint filed last March 10. 2021 against this facility. LPA met with Administrator Glen Goldsmith. LPA stated the purpose of the visit; and discussed the following findings. On allegation that facility charged resident for service not received, the following are the findings. Per file review and interviews, facility offered weekly laundry services for personal clothing as an optional service for an additional fee. Per interviews, around the latter half of December 2020, facility staff in charge of the laundry service was out of the facility. Four of seven residents that subscribed for weekly laundry services observed stated that their laundry piled up and were left unattended for at least a week. Based on the above findings, the preponderance of the evidence standard has been met. Therefore, the above allegation is found SUBSTANTIATED. (Page 1/2) Substantiated Continuation from Page 1 Deficiency was observed, and citation was issued per Title 22 Division 6 of the California Code of Regulations. LPA Marin conducted an exit interview with AD Goldsmith. LPA discussed the deficiency, citation, and appeal rights. Copies of this report, Deficiency Page and appeal rights were left in the facility. This Department has investigated the complaint alleging facility charged resident a monetary fine not listed in admissions agreement. We have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. We have therefore dismissed the allegation. LPA Marin conducted an exit interview with AD Goldsmith and copy of this report was left in the facility. Page 2/2the state’s words, verbatim · CDSS document, Sep 22, 2022 · control 22-AS-20210310124338

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87507(g)(2) · Plan of correction due date: Oct 13, 2022

87507 Admission Agreements. Admission agreements shall specify the following: Additional items and services which are available. This requirement was not met as evidenced by: Based on file review and interview, facility missed to provide the available services indicated by the residents in the admission agreement. Facility missed to provide weekly laundry services to specific residents that paid for their optional services. This posed potential threat on health and safety of the residents in care.the state’s words, verbatim · CDSS document, Sep 22, 2022

Plan of correction: Facility will ensure will that there is a substitute staff who will be available to meet the optional services offered by the facility. Corrected at the time of the visit.

Allegation investigated: A resident is being mistreated by another resident while in care.

Licensing Program Analyst (LPA) Albert Marin made an unannounced visit to this facility to deliver the final report for the investigation completed for the complaint received last December 16, 2020 against this facility. LPA met with Administrator (AD) Glen Goldsmith and stated the purpose of this visit. LPA discussed the findings. On allegation that a resident is being mistreated by another resident while in care, based on observation, file review and interviews the following are the findings. Based June 29, 2020 Physician’s Report, Resident 1 had primary diagnosis of chronic obstructive pulmonary disease (COPD) and secondary diagnosis of a psychiatric disorder. R1 was determined to be able to follow instructions, able to communicate needs and able to leave facility unassisted. R1 was not determined to have inappropriate or aggressive behavior. Based on the observation log from January 2020 to January 2021, there had been about 13 recorded incidents wherein R1 was observed to have aggressive or disruptive behavior commonly manifested as loud screaming and disrespectful notably to staff members, and residents (Continuation in Page 2) Substantiated (Continuation from Page 1) Facility issued written warnings against these behaviors as early as June 2016, followed by warning issued on September and October 2020. On February 2021, facility issued a 30 day eviction notice against R1 on the grounds of violating the house rules in multiple occasions. Based on the above findings, the preponderance of the evidence standard has been met. Therefore, the above allegation is found SUBSTANTIATED. Deficiency had been observed. Citations was issued per Title 22 Division 6 of the California Code of Regulations. LPA Marin conducted an exit interview with Ad Glen Goldsmith. Copies of this report, deficiency page, and appeal rights were left in the facility.the state’s words, verbatim · CDSS document, Sep 22, 2022 · control 22-AS-20201216111753

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.1(a)(1) · Plan of correction due date: Sep 23, 2022

87468.1 Personal Rights of Residents in All Facilities. Residents in all residential care facilities for the elderly shall have all of the following personal rights: To be accorded dignity in their personal relationships with staff, residents, and other persons. This requirement was not met as evidenced by: Based on observation, interviews and file review, facility missed to ensure that all residents are accorded dignity in their personal relationship with staff, residents, and other persons. R1 was observed to have about 13 incidents of verbal abuse towards staff and other residents. This posed immediate threat against personal rights of the residents in care.the state’s words, verbatim · CDSS document, Sep 22, 2022

Plan of correction: Facility will ensure that residents are properly assessed for any potential behavior issues, and addressed new behavior issues as such by promptly referring residents to appropriate medical professional for assessment and support. Threat reduced.

Allegation investigated: Resident wandered away from the facility

Licensing Program Analyst (LPA) Albert Marin made an unannounced visit to this facility to deliver the final report for the investigation completed for the complaint received last November 16, 2020 against this facility. LPA met with Administrator (AD) Glen Goldsmith and stated the purpose of this visit. On allegation that resident wandered away from the facility, based on observation, file review and interviews the following are the findings. Resident 1 (R1) had been living in the facility since April 2014. R1 was placed under conservatorship. On April 2016 Physician’s Report, R1 was diagnosed with Schizophrenia, Paranoid Type; and determined to have wandering behavior, and not able to leave the facility unassisted due to conservatorship. Based on October 17, 2019 Individual Service Plan, it indicated that under conservator care permission needed to step out the facility for home pass. Based on observation logs provided, May 8, 2020, R1 violated the house rule. R1 left facility to go to store next door. R1 was brought back by staff. May 19, 2020, R1 violated house rule. Left to the liquor market and refused to listen. August 29, 2020, R1 was seen and observed to be awake all night walking up and down. There was an endorsement to follow up for further medication evaluation. (Continuation in Page 2 ) Substantiated (Continuation from Page 1) Based on October 21,2020 Physician’s Report, Resident 1 (R1) had primary diagnosis as previously stated. R1 was determined to have no wandering behavior and able to leave the facility unassisted. R1 remained under conservatorship. On November 12, 2020 about 4:12 PM, R1 got out of the facility unassisted. No sign out log was completed. No staff member observed R1 exited the facility. About 4:30 PM, R1 was witnessed to be at the intersection of Brookhurst and Cerritos Avenue, (estimated to be about 1.4 miles from the facility) Based on medical records, R1 was brought in the emergency department of a hospital at 6:59 PM via an ambulance. Per history provided, R1 tripped and had a ground level fall with loss of consciousness for unspecified duration. R1 was eventually admitted for further evaluation and management. It was on November 13, 2020 5:24 AM, a missing person report was made to the police department. Based on the above findings, the preponderance of the evidence standard has been met. Therefore, the above allegation is found SUBSTANTIATED. Deficiency had been observed. Citation is issued per Title 22 Division 6 of the California Code of Regulations. LPA Marin conducted an exit interview with AD Glen Goldsmith. Copies of this report, deficiency page, civil penalty assessment form, appeal rights, and cited regulation were left in the facility.the state’s words, verbatim · CDSS document, Sep 22, 2022 · control 22-AS-20201116094344

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87411(a) · Plan of correction due date: Sep 23, 2022

87411 Personnel Requirements - General (a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. This requirement was not met as evidenced by: Based on observation, file review and interviews, the facility missed to provide facility personnel ..to meet resident needs.R1 was observed to be violating the house rules on leaving the facility unassisted; and recent wander episode prior to the incident. Facility missed to provide additional services to address change of behavior of resident. This posed immediate threat on safety of resident in care.the state’s words, verbatim · CDSS document, Sep 22, 2022

Plan of correction: Facility will ensure that there are adequate staff to monitor movement of residents in and out of the facility. Threat reduced. Civil penalty was assessed. Copy of the cited regulation was provided for full reference.

Allegation investigated: Staff failed to provide a safe environment for resident. Staff failed to meet resident's needs.

Licensing Program Analyst (LPA) Albert Marin made an unannounced visit to this facility to deliver the final report for the investigation completed for the complaint filed last December 12, 2021 against this facility. LPA met with Administrator (AD) Glen Goldsmith and stated the purpose of this visit; and discussed the following findings. On allegation that staff failed to provide safe environment for the resident, the following are the findings. It was reported that one resident had verbal exchanges with two other residents in the facility; and was threatened to poison food in this facility. Based on interviews, witnesses stated that there had been no reported incident of food poisoning in the facility. Meals served to the residents are directly served from the kitchen and only served or handled by dining hall or kitchen staff. Residents were never permitted to assist or share meals with other residents while in the dining hall and during meal service. Thus, the above allegation was UNFOUNDED. (Page 1/2) Unfounded On allegation that staff failed to meet resident's needs, the following are the findings. It was reported that resident experienced severe pain and was not given any medication to relieve the symptom. Resident was prescribed with as needed pain medication. Per interviews, Resident 1 did not disclose any need for pain medication nor any medication to manage other symptoms. Thus, the allegation was UNFOUNDED. The Department has investigated the complaint alleging that staff failed to provide a safe environment for resident; and that staff failed to meet resident's needs. We have found that the complaint was unfounded, meaning that the allegations were false, could not have happened and/or are without a reasonable basis. We have therefore dismissed the complaint LPA Marin conducted an exit interview with AD Glen Goldsmith and copy of this report was left in the facility. Page 2/2the state’s words, verbatim · CDSS document, Sep 22, 2022 · control 22-AS-20211209161303

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Jerome Haley conducted an unannounced case management visit at New Horizon Lodge. LPA was greeted, and explained the reason for the visit. LPA Haley met with Assistant Administrator Sarah Zarate, and (AD) Administrator Glen Goldsmith. The purpose of today's visit was to conduct a Case Management visit to discuss an Unusual Incident Report (LIC 624) that was sent to the Orange County Adult and Senior Care Program Regional Office September 7, 2022 that involved Resident 1 (R1). During the visit LPA Haley received copies of R1's Admission Agreement, Physician's Report, and Individualized Service Plan. Furthermore, LPA Haley and AD Goldsmith briefly spoke about Resident 2 (R2) and the ongoing complaint investigation. Complaint Control Number: 22-AS-20220621171421 No deficiencies are being cited during today's Case Management visit. An exit interview was conducted and a copy of this report and LIC 811 was provided.the state’s words, verbatim · CDSS document, Sep 9, 2022

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Jerome Haley conducted an unannounced case management visit at New Horizon Lodge. LPA was greeted, granted entry by staff and explained the reason for the visit. LPA Haley met with Administrator Glen Goldsmith. The purpose of today's visit was to conduct a Case Management visit to discuss an Unusual Incident Report (LIC 624) that was sent to the Orange County Adult and Senior Care Regional Office August 22, 2022. On today's visit LPA Haley conducted interviews with residents and staff regarding the incident involving Resident 1 (R1) on July 31, 2022. AD Goldsmith will be emailing a copy of R1's Admission Agreement, Individual Service Plan and Physicians Report. No deficiencies are being cited during today's Case Management visit. An exit interview was conducted and a copy of this report and LIC 811 was provided.the state’s words, verbatim · CDSS document, Aug 23, 2022

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Jerome Haley conducted an unannounced case management at Harvest Retirement. LPA was greeted, granted entry by staff and explained the reason for the visit. LPA Haley met with Assistant Administrator Sarah Zarate. The purpose of today's visit was to conduct a Case Management visit to discuss an Unusual Incident Report (LIC 624) that was sent to the Orange County Adult and Senior Care Program Regional Office July 19, 2022. On today's visit LPA Haley conducted an interview regarding the incident involving Resident 1 (R1) on July 17, 2022. LPA Haley received copies of R1's Face Sheet, Admission Agreement, Preplacement Appraisal, a copy of an email exchange, and Physician's Report. LPA Haley left a copy of the COVID 19 informational flyer from the California Department of Public Health dated June 30, 2022. No deficiencies are being cited during today's Case Management visit. An exit interview was conducted and a copy of this report and LIC 811 was provided.the state’s words, verbatim · CDSS document, Jul 29, 2022

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Jerome Haley conducted an unannounced case management at Harvest Retirement. LPA was greeted, granted entry by staff and explained the reason for the visit. LPA Haley met with Assistant Administrator Sarah Zarate. The purpose of today's visit was to conduct a Case Management visit to discuss an Unusual Incident Report (LIC 624) that was sent to the Orange County Adult and Senior Care Program Regional Office July 22, 2022. On today's visit LPA Haley conducted an interview regarding the incident involving Resident 1 (R1) on July 18, 2022. LPA Haley received copies of R1's Face Sheet, Preplacement Appraisal, and Physician's Report. No deficiencies are being cited during today's Case Management visit. An exit interview was conducted and a copy of this report and LIC 811 was provided.the state’s words, verbatim · CDSS document, Jul 29, 2022

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Jerome Haley conducted an unannounced case management visit at New Horizon Lodge. LPA was greeted, granted entry by staff and explained the reason for the visit. LPA Haley met with Assistant Administrator Sarah Zarate. The purpose of today's visit was to conduct a Case Management visit to discuss an Unusual Incident Report (LIC 624) that was sent to the Orange County Adult and Senior Care Program Regional Office July 22, 2022. On today's visit LPA Haley conducted an interview regarding the incident involving Resident 1 (R1) on July 18, 2022. LPA Haley received copies of R1's Face Sheet, Preplacement Appraisal, and Physician's Report. No deficiencies are being cited during today's Case Management visit. An exit interview was conducted and a copy of this report and LIC 811 was provided.the state’s words, verbatim · CDSS document, Jul 29, 2022

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Jerome Haley conducted an unannounced case management visit at New Horizon Lodge. LPA was greeted, granted entry by staff and explained the reason for the visit. LPA Haley met with Assistant Administrator Sarah Zarate. The purpose of today's visit was to conduct a Case Management visit to discuss an Unusual Incident Report (LIC 624) that was sent to the Orange County Adult and Senior Care Program Regional Office July 19, 2022. On today's visit LPA Haley conducted an interview regarding the incident involving Resident 1 (R1) on July 17, 2022. LPA Haley received copies of R1's Face Sheet, Admission Agreement, Preplacement Appraisal, a copy of an email exchange, and Physician's Report. LPA Haley left a copy of the COVID 19 informational flyer from the California Department of Public Health dated June 30, 2022. No deficiencies are being cited during today's Case Management visit. An exit interview was conducted and a copy of this report and LIC 811 was provided.the state’s words, verbatim · CDSS document, Jul 29, 2022

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Jerome Haley conducted an unannounced case management visit to New Horizon Lodge INC. LPA was greeted, granted entry by staff and explained the reason for the visit. The purpose today's visit was to conduct a Case Management visit to discuss an Unusual Incident Report (LIC 624) that was sent to the Orange County Adult and Senior Care Regional Office June 23, 2022. On today's visit LPA Haley discussed the incident report regarding Resident 1 (R1) with Assistant Administrator Sarah Zarate. LPA Haley received copies of R1's Admission Agreement, Individual Service Plan, and Physicians Report. No deficiencies are being cited during today's Case Management visit. An exit interview was conducted with Administrator Zarate and a copy of this report was provided.the state’s words, verbatim · CDSS document, Jun 27, 2022

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Jerome Haley made an unannounced visit for the purpose of conducting a Case Management visit regarding an Unusual Incident Report (LIC 624) received from facility on 02/23/2022. LPA was greeted at the reception desk by Administrator Glen Goldsmith and explained the reason for the visit today. LPA interviewed AD Goldsmith and Staff 1 (S1) concerning the February 18 incident regarding Resident 1 (R1). On 02/18/2022, R1 exhibited escalating inappropriate behavior of a sexual nature. The behavior was both physical and verbal, and it was directed towards some female staff and residents. LPA Haley requested Resident 1's (R1) files. LPA reviewed and obtained copies of R1's: Basic Fact Sheet, Individualized Service Plan, Physicians Report, and Preplacement Appraisal Information (page 1). LPA explained if further follow up is required, LPA Haley will return at a later date to continue follow up of this incident. No deficiencies cited at this time. An exit interview was conducted with Administrator Goldsmith and a copy of this report was provided.the state’s words, verbatim · CDSS document, Feb 25, 2022

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Albert Marin made an unannounced required annual inspection in this facility. LPA met with Administrators(AD) Glen Goldsmith and stated the purpose of this visit. The facility is a two level structure and licensed capacity of 120 of which 58 are non-ambulatory and on first floor only. Facility has hospice waiver for 18. For this visit, there were three residents under hospice care. About 12:00 PM , LPA Marin was granted entry after completing the Coronavirus 2019 (COVID 19) screening procedure. LPA toured the interior and exterior portions of the facility with AD Goldsmith. LPA observed new sprinkler system in place in the common areas and residents rooms. Resident's rooms are generally shared and provided with private bathrooms. LPA inspected random rooms and observed to be provided with furniture in good repair, clean linens, adequate storage space, and kept free of tripping hazards. Smoke, and carbon monoxide alarms were observed to be in working conditions. Sprinkler and water system was tested last April 13, 2021. AD agreed to provide Community Care Licensing Division with copy of the latest fire alarm testing. Random call system were tested to be operational on both floors. Bathrooms were observed to be in good repair. Hot water was measured between 105 - 110 degrees Fahrenheit. Kitchen and dining area appeared in order and clutter free. LPA received a copy of December 2021 Dietitian Inspection with no immediate health and safety concerns. Facility met the minimum two day supply of perishable and seven day supply of non-perishable food stock requirements. Medications, cleaning supplies and sharp items were inaccessible to residents in care. Fire extinguishers were mounted and charged. For the exterior portion, facility had outside furniture in good repair; and grounds were free of tripping hazards. LPA observed the required poster and information requirements. LPA Marin reviewed the COVID 19 mitigation plan of the facility. For this visit, the facility was observed to be in substantial compliance with Title 22 Division 6 of the California Code of Regulations. LPA Marin conducted an exit interview with AD Glen Goldsmith; and copy of this report was left in the facility.the state’s words, verbatim · CDSS document, Dec 15, 2021

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Albert Marin made an unannounced visit to this facility to conduct a case management visit for an incident. LPA met with Administrator (AD)_ Glen Goldsmith and stated the purpose of this visit. On July 1, 2021, Community Care Licensing Division (CCLD) received a verbal report from AD Goldsmith about Resident 1 who was tested positive for banned substance during a random routine blood testing conducted outside the facility. On July 9, 2021, CCLD received the written report. About 9:31 AM, LPA Marin conducted interview and file review. AD Goldsmith discussed the progress and the current status of the resident, with no further untoward incident. For this visit, no citation was issued at this time. LPA Marin conducted an exit interview with AD Goldsmith and copy of this report was left in the facility.the state’s words, verbatim · CDSS document, Jul 16, 2021