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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 336423469
Report Date: 10/31/2022
Date Signed: 10/31/2022 11:06:19 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/29/2021 and conducted by Evaluator Natalie Ibarra
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20210129150900
FACILITY NAME:NEW DISCOVERY RESIDENTIAL SERVICES #4FACILITY NUMBER:
336423469
ADMINISTRATOR:CLARDY, GEORGEFACILITY TYPE:
735
ADDRESS:903 UNION ST.TELEPHONE:
(951) 381-4130
CITY:BEAUMONTSTATE: CAZIP CODE:
92223
CAPACITY:4CENSUS: 4DATE:
10/31/2022
UNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Donna WeldonTIME COMPLETED:
11:15 AM
ALLEGATION(S):
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Resident sustained pressure injuries while in care
Licensee did not assist resident with obtaining medical care
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs) Natalie Ibarra and Paola Guerrero made an unannounced visit to the facility to deliver findings for the above allegations. LPAs met with Administrator Donna Weldon and explained the purpose of today’s visit. The investigation consisted of interviews with pertinent parties and record review.

The first allegation indicates resident sustained pressure injuries while in care. Interviews with Staff #2 (S2) and Staff #3 (S3) indicated that Client #1 (C1) does not have any bed sore on the bottom of their feet. S2 and S3 stated that C1 had a small red spot on top of their foot by the ankle but that red spot was not a pressure sore. S2 stated redness is due to C1 laying in fetal position while in bed and puts weight on one foot with the other. LPA did not observe any sores on the bottom of C1’s feet. LPA reviewed note from urgent care visit with a diagnosis of skin change. There was no diagnosis for bed and/or pressure sores on C1’s feet.


Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Natalie Ibarra
LICENSING EVALUATOR SIGNATURE:

DATE: 10/31/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/31/2022
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 2
Control Number 18-AS-20210129150900
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: NEW DISCOVERY RESIDENTIAL SERVICES #4
FACILITY NUMBER: 336423469
VISIT DATE: 10/31/2022
NARRATIVE
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The second allegation indicates licensee did not assist resident with obtaining medical care. Interviews with S2 and S3 stated C1 has recently come out of quarantine due to covid and administrator was informed about red spot by ankle. S2 stated C1’s doctor did see red spot and advised to put cream on it. LPA reviewed urgent care discharge papers that show C1 was taken to urgent care on 2/6/21 to be seen for the red spot near ankle.

Based on the information obtained, the allegations are UNSUBSTANTIATED. A finding of UNSUBSTANTIATED means that although the allegation may have happened or is valid, there is not a
preponderance of evidence to prove the alleged violations did or did not occur.

No deficiencies were cited during this visit.
An exit interview was conducted, and a copy of this report was provided to the Administrator Donna Weldon.



***Second page of LIC 9099C amended due to no signatures obtained on original***
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Natalie Ibarra
LICENSING EVALUATOR SIGNATURE:

DATE: 10/31/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/31/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2