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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 366423467
Report Date: 03/05/2025
Date Signed: 03/05/2025 11:15:46 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO ASC, 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 Becky Mann
COMPLAINT CONTROL NUMBER: 18-AS-20210129125804

FACILITY NAME:NEW DISCOVERY RESIDENTIAL SERVICES #5FACILITY NUMBER:
366423467
ADMINISTRATOR:ERICA REYESFACILITY TYPE:
735
ADDRESS:33974 AVENUE "H"TELEPHONE:
(909) 918-0059
CITY:YUCAIPASTATE: CAZIP CODE:
92399
CAPACITY:4CENSUS: 3DATE:
03/05/2025
UNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:Sharda Dawson, Direct Support ProfessionalTIME COMPLETED:
11:20 AM
ALLEGATION(S):
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Licensee did not assist residents with basic services
Facility flooring not maintained clean
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Becky Mann conducted an unannounced visit to the facility to initiate a complaint investigation. LPA met with Sharda Dawson, Direct Support Professional (DSP) and discussed the purpose of the visit. The investigation consisted of LPA pertinent record reviews and interviews with staff and residents.

The allegation that Licensee did not assist residents with basic services. All clients interviewed stated that staff does assist with basic services. Based on LPA observations, residents are well groomed, and their clothes are washed and clean. All staff interviewed help assist residents with basic services.

The allegation that Facility flooring not maintained clean. Based on LPA observations, the facility floor is clean and maintained. Staff does maintain the flooring by cleaning it.

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Becky Mann
LICENSING EVALUATOR SIGNATURE:

DATE: 03/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 18-AS-20210129125804
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: NEW DISCOVERY RESIDENTIAL SERVICES #5
FACILITY NUMBER: 366423467
VISIT DATE: 03/05/2025
NARRATIVE
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Based on evidence obtained during this investigation, the allegations above are Unsubstantiated; meaning that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur.

An exit interview was conducted where this report was discussed and a copy of this report was provided to the Sharda Dawson, DSP at the conclusion of the visit
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Becky Mann
LICENSING EVALUATOR SIGNATURE:

DATE: 03/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3