366423467-9-1-2021-18-AS-EMAN-C76NPM-20210924103834

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 366423467
Report Date: 09/01/2021
Date Signed: 09/01/2021 02:24:14 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
08/25/2021 and conducted by Evaluator Melody Brown

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20210825081250

FACILITY NAME:	NEW DISCOVERY RESIDENTIAL SERVICES #5		FACILITY NUMBER:	366423467
ADMINISTRATOR:	ERICA REYES		FACILITY TYPE:	735
ADDRESS:	33974 AVENUE "H"		TELEPHONE:	(909) 918-0059
CITY:	YUCAIPA	STATE: CA	ZIP CODE:	92399
CAPACITY:	4	CENSUS: 3	DATE:	09/01/2021
		UNANNOUNCED	TIME BEGAN:	10:55 AM
MET WITH:	Donna J Weldon		TIME COMPLETED:	02:40 PM

ALLEGATION(S):

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Staff hits resident
Facility not allowing resident(s) to attend Day Program

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Melody Brown conducted an unannounced visit to the facility to commence a complaint investigation. LPA Brown was greeted and granted entrance by Administrator Donna J. Weldon. LPA Brown identified herself and discussed the purpose of the visit and the elements of the allegations with Administrator Weldon.

The investigation consisted of file review and interviews with relevant parties. The allegation indicates that staff hits Resident. Staffs were interviewed and denied resident being hit. Staff 1-4 (S1 -S4) denied ever hitting any residents and denied witnessing another staff member hitting any residents in care. Resident 1 (R1) stated S3 hit them in the mouth, legs and arm. LPA Brown did not observe any sign or symptom of injury. Resident 2 (R2) stated they have never seen any staff, including S3, ever hit any residents in care. Per review of R1’s Positive Support Plan, it was reported that R1 makes false complaints and/or statements that staff or peers have harmed her.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Melody Brown
LICENSING EVALUATOR SIGNATURE:	DATE: 09/01/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2021

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 18-AS-20210825081250

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: NEW DISCOVERY RESIDENTIAL SERVICES #5	FACILITY NUMBER: 366423467
	VISIT DATE: 09/01/2021

NARRATIVE

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The second allegation indicates that the facility does not allow residents to attend the Day Program. Based on interviews with staff, residents, and records review, LPA Brown did not find evidence to corroborate the allegation. Records review and interview with Consumer Services Coordinator (CSC) staff indicated that the facility was not the one that did not allow R2 to attend the day program. CSC staff also added that R2 was not on Day Program for more than two (2) years now because of R2’s behavioral issues. Investigation and records review also revealed that R3 is currently enrolled in a Day Program and R1 was allowed to return to Day Program but was expelled due to behavior issues.

Based on interviews and observations, and although the above allegations may have occurred or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED at this time.

No deficiencies were cited during this visit. An exit interview was conducted where this report was discussed and provided to Administrator Weldon.

SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Melody Brown
LICENSING EVALUATOR SIGNATURE:	DATE: 09/01/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2021

LIC9099 (FAS) - (06/04)

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