<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336423469
Report Date: 06/21/2023
Date Signed: 06/21/2023 03:16:58 PM

Document Has Been Signed on 06/21/2023 03:16 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
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, 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: DATE:
06/21/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:40 PM
MET WITH:Bryan Clardy, AdministratorTIME COMPLETED:
03:20 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Magda Malcore made an unannounced visit to the facility to conduct an annual inspection. LPA met with Bryan Clardy, Administrator and discussed the purpose of the visit. The facility is an Adult Residential Facility (ARF) with a capacity of (4) and a census of (4). The facility has (4) client bedrooms, (1) theater room, 2 1/2 bathrooms with a kitchen/dining area, living room, and attached garage. LPA conducted an overall inspection of the facility, which included, but was not limited to, the following:

LPA inspected the facility inside and out. Indoor and outdoor passageways were kept free of obstruction. Facility has a covered patio and no bodies of water. Backyard is fenced with a self latching gate. Facility telephone service is working properly. Laundry equipment is in good repair. The facility has sufficient furniture and lighting and is maintained at a comfortable temperature of 72 degrees F.

LPA inspected the kitchen. The hot water temperature tested within regulation at 105 degrees F. Facility has sufficient supply of nonperishable and perishable food. Facility monthly menu has a variety of meals planned and is posted in the kitchen. Facility food is stored in a safe and healthful manner. Facility has a sufficient supply of cups, plates, utensils. Sharps are stored and kept locked in kitchen cabinet and inaccessible to clients in care.

LPA inspected (4) client bedrooms. Bedrooms are equipped with clean mattresses, nightstands, chairs, storage space, linen and sufficient lighting.

SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Magda Malcore
LICENSING EVALUATOR SIGNATURE: DATE: 06/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/21/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: 06/21/2023
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
LPA inspected the 2 1/2 bathrooms. Bathrooms were operating in a safe and sanitary condition. The hot water temperature tested within regulation at 112 degrees F.

LPA observed the facility is equipped with operating carbon monoxide alarms and fully charged fire extinguisher which was serviced November 2022. Last fire Drill & Earthquake drill conducted on 6/2/23. Personal rights, emergency disaster plan, and Community Care Licensing posters, were posted in a common area. Cleaning supplies, toxins, items were kept locked and inaccessible to clients in care.

LPA reviewed (4) client medications. Medications were dispensed appropriately according to the physician's orders. LPA observed medications are kept in a safe and locked cabinet inaccessible to clients. Facility has a complete first aid kit and emergency supplies. Facility has a sufficient supply of linens, towels, and hygiene products.

LPA reviewed four (4) client files for admission agreements, physician reports, and Individual Program Plans (IPPs), all had the required documentation.

LPA reviewed (2) staff files for First Aid/CPR certification, criminal record clearance, training, and health screenings, all had the required documentation.

Overall, the facility is clean, in good repair, and operating in safe conditions for clients in care. No deficiencies were cited during today's visit.

An exit interview was conducted where this report was discussed and a copy was provided to Bryan Clardy at the conclusion of the visit.

SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Magda Malcore
LICENSING EVALUATOR SIGNATURE:

DATE: 06/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/21/2023
LIC809 (FAS) - (06/04)
Page: 2 of 2