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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198602405
Report Date: 07/05/2023
Date Signed: 07/05/2023 01:32:48 PM

Document Has Been Signed on 07/05/2023 01:32 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
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME:ANEW DIRECTION ADULT LIVINGFACILITY NUMBER:
198602405
ADMINISTRATOR:PATRICIA DUFRENNEFACILITY TYPE:
735
ADDRESS:2300 S PACIFIC AVETELEPHONE:
(909) 210-0365
CITY:SAN PEDROSTATE: CAZIP CODE:
90731
CAPACITY: 72CENSUS: 59DATE:
07/05/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:25 AM
MET WITH:Joice Garcia-Assistant AdministratorTIME COMPLETED:
01:32 PM
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On 07/05/23, Licensing Program Analyst, LPA Alfonso Iniguez conducted a Case Management visit to follow up on the death report that department received on 7/3/23. LPA was greeted by Joyce Garcia/Assistant Administrator (S1) an explained the purpose of the visit is to gather information surrounding the death of (C1).

The regional office received a copy of the death report from the facility and reported the death of (C1) on 07/03/23. The death report stated that (C1) passed away on 07/03/23 at 12:10 AM in room 11 at the facility.

The following documents and interviews were retrieved and conducted:

· Client Tracking Notes and documentation of staff rounds for the months of: May, June, and July of 2023.
· Staff Work Schedule- LIC 500.
· Copy C1-C5 client records.
· LPA conducted Interviews with the following: S1-S3 and C2-C11.
· LPA reviewed 7/2/2023 and 7/3/2023 PM video recording.

LPA requested a copy of the coroner’s report, police report, death certificate and a copy of the CCTV video footage form 7/2/23 at 5:00PM-7/3/23 at 2:00AM. Once obtained, facility will provide a copy to the regional office.

An exit interview was conducted with Joyce Garcia/Assistant Administrator and a hard copy was provided.

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Alfonso Iniguez
LICENSING EVALUATOR SIGNATURE: DATE: 07/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/05/2023
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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