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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 075650136
Report Date: 07/28/2023
Date Signed: 07/28/2023 03:01:37 PM

Document Has Been Signed on 07/28/2023 03:01 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
CENTRAL COAST SC/RES, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:CENTER FOR DISCOVERY - BRENTWOODFACILITY NUMBER:
075650136
ADMINISTRATOR:FACILITY TYPE:
730
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 6CENSUS: 4DATE:
07/28/2023
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
01:50 PM
MET WITH:Administrator Sara StokesTIME COMPLETED:
02:15 PM
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On 7/28/23, Licensing Program Analyst (LPA) Mariah Hawkins conducted a visit to the facility for the annual continuation. LPA met with Administrator Sara Stokes and informed of the purpose of the visit.

An agreement was made to have Administrator send copies of resident and personnel records to LPA for review. LPA reviewed files for 4 residents and 5 staff, including four direct care staff / lead staff (facility managers) and one therapist. LPA observed records to be complete.

Administrator updated LPA that a plumber came to inspect the hot water and informed that when the water heater is turned down low enough for the faucets close to the water heater to be below the upper limit of the permitted temperature range, then the faucets, including the showers, on the opposite end of the facility do not meet the lower limit of the range. Administrator stated a plumber would be called to further inspect the plumbing system and agreed to provide updates to LPA.

No deficiencies were observed.

An exit interview was conducted, appeal rights discussed, and a copy of this report was left with Administrator Sara Stokes, whose signature on this form confirms receipt.
SUPERVISORS NAME: Isabel Diego
LICENSING EVALUATOR NAME: Mariah Hawkins
LICENSING EVALUATOR SIGNATURE: DATE: 07/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/28/2023
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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