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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 075650136
Report Date: 07/01/2022
Date Signed: 07/01/2022 01:11:25 PM

Document Has Been Signed on 07/01/2022 01:11 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, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:CENTER FOR DISCOVERY - BRENTWOODFACILITY NUMBER:
075650136
ADMINISTRATOR:SARA STOKESFACILITY TYPE:
730
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 6CENSUS: 4DATE:
07/01/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Mental Health Technician Latiesha O'NealTIME COMPLETED:
01:15 PM
NARRATIVE
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On 7/1/22, Licensing Program Analyst (LPA) Mariah Hawkins made a visit to the residential treatment group home facility for a case management visit. LPA met with Mental Health Technician Latiesha O'Neal and informed of the purpose of the visit.

During an investigation at the facility, it was discovered that a youth made a disclosure of inappropriate sexual behaviors from a staff toward the youth, but the facility did not report this incident due to not believing the youth's statement. Additionally, during the investigation, an investigator with the Licensing agency's Investigations Branch (IB), after introducing self and requesting to interview residents, was denied permission to do so. The investigator went over the Licensing agency's inspection authority and was still denied.

Lastly, during today's visit, LPA was informed that Interim Administrator Virginia Parish is out on sick leave, and the facility manager is working "virtually." There are currently four (4) residents and three (3) staff, including two (2) direct care staff (mental health technicians) and one (1) therapist. The therapist was in a session and not able to provide supervision on the floor nor represent the facility during today's visit. The facility was previously issued an advisory on 05/18/2022 that the facility needs to ensure there is always a facility manager present when children are present whenever the administrator is absent and that the facility may designate more than one facility manager at a facility.

LPA is issuing three (3) citations of California Code of Regulations, Title 22, Division 6, Chapter 1, Article 6, Section 80061 Reporting Requirements, Section 80044 Inspection Authority of the Licensing Agency, and Chapter 5, Article 6, Section 84065 Personnel Requirements. See attached LIC 809-D pages.

An exit interview was conducted, appeal rights provided, and a copy of this report left with Mental Health Technician Latiesha O'Neal, whose signature on this form confirms receipt.
Isabel Mendoza
Mariah Hawkins
DATE: 07/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/01/2022
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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Document Has Been Signed on 07/01/2022 01:11 PM - It Cannot Be Edited


Created By: Mariah Hawkins On 07/01/2022 at 09:50 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: CENTER FOR DISCOVERY - BRENTWOOD
FACILITY NUMBER: 075650136

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/01/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/05/2022
Section Cited

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80061 Reporting Requirements
(b) Upon the occurrence...of any of the events ...a report shall be made... within...next working day...In addition, a written report...shall be submitted...within seven days...(1)(E) Any unusual incident...which threatens the physical or emotional health or safety of any client.
This requirement is not met as evidenced by:
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Based on interview and record review, the licensee did not ensure reportable incident was reported due to a youth's disclosure of staff sexual behavior not being reported due to facility not believing youth. This poses an immediate Health, Safety, or Personal Rights risk to residents in care.
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Type B
07/18/2022
Section Cited

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80044 Inspection Authority of the Licensing Agency
(b) The licensing agency shall have the authority to interview clients, including children, or staff members, without prior consent.
This requirement is not met as evidenced by:
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Based on observation and interview, the licensee did not ensure inspection authority was respected due to Licensing agency investigator being denied more than once permission to interview the residents. This 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:Isabel Mendoza
LICENSING EVALUATOR NAME:Mariah Hawkins
LICENSING EVALUATOR SIGNATURE:
DATE: 07/01/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/01/2022


LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 07/01/2022 01:11 PM - It Cannot Be Edited


Created By: Mariah Hawkins On 07/01/2022 at 12:10 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: CENTER FOR DISCOVERY - BRENTWOOD
FACILITY NUMBER: 075650136

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/01/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/18/2022
Section Cited

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84065 Personnel Requirements
(d) The licensee shall designate at least one facility manager to be present at the facility at all times when children are present...
This requirement is not met as evidenced by:
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Based on observation and interview, licensee did not ensure facility manager coverage while administrator is absent due to there being four residents and no facility manager on site. This 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:Isabel Mendoza
LICENSING EVALUATOR NAME:Mariah Hawkins
LICENSING EVALUATOR SIGNATURE:
DATE: 07/01/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/01/2022


LIC809 (FAS) - (06/04)
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