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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336423469
Report Date: 05/26/2023
Date Signed: 05/26/2023 08:33:12 AM

Document Has Been Signed on 05/26/2023 08:33 AM - 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, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507
FACILITY NAME:NEW DISCOVERY RESIDENTIAL SERVICES #4FACILITY NUMBER:
336423469
ADMINISTRATOR:DONNA WELDONFACILITY TYPE:
735
ADDRESS:903 UNION ST.TELEPHONE:
(951) 381-4130
CITY:BEAUMONTSTATE: CAZIP CODE:
92223
CAPACITY: 4CENSUS: 4DATE:
05/26/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:25 AM
MET WITH:Bryan Clardy- AdministratorTIME COMPLETED:
09:00 AM
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LPA Bernadette Allen conducted this Case Management visit at NEW DISCOVERY RESIDENTIAL SERVICES II, 3750 OLEANDER DR, HIGHLAND, CA 92346- Facility number 366424638 to obtain signatures on a amended copy of a 9099 originally dated and signed on 5/25/2023, regarding complaint control number COMPLAINT CONTROL NUMBER: 56-AS-20230518155907.

LPA Allen requested that the administrator Bryan Clardy sign amended 9099 correcting the allegation findings from Unsubstantiated to Unfounded.

An exit interview was conducted and discussed with the administrator and a copy of the report was provided at the conclusion of the visit

SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Bernadette Allen
LICENSING EVALUATOR SIGNATURE: DATE: 05/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/26/2023
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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