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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 366424638
Report Date: 09/19/2023
Date Signed: 09/19/2023 12:38:46 PM

Document Has Been Signed on 09/19/2023 12:38 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
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507
FACILITY NAME:NEW DISCOVERY RESIDENTIAL SERVICES IIFACILITY NUMBER:
366424638
ADMINISTRATOR:VIVIAN FRANCISCOFACILITY TYPE:
735
ADDRESS:3750 OLEANDER DR.TELEPHONE:
(909) 280-9638
CITY:HIGHLANDSTATE: CAZIP CODE:
92346
CAPACITY: 6CENSUS: 2DATE:
09/19/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:36 AM
MET WITH:Vivian FranciscoTIME COMPLETED:
12:40 PM
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Licensing Program Analyst (LPA) Anna Bueno made an unannounced visit to the facility in order to initiate a case management visit due to a recent death of a client at the facility. LPA identified herself to Administrator Vivian Francisco, who was also informed of the purpose of the visit. LPA Bueno and Administrator Francisco toured the facility and LPA did not observed health and safety concerns during the visit.

On this day, the Department was notified of the death of Client 1 (C1). During today's visit, LPA Bueno interviewed Staff 1 (S1) regarding the details surrounding C1's death. LPA also collected and reviewed records that are pertinent to C1's death, including:
  • Recent Physician report, LIC602
  • Facility Charting Notes
  • Facility Logs
  • Recent Medical visit records

LPA Bueno also requested additional documentation be sent to the Department; such as, the Death Certificate, upon availability.

An exit interview was conducted where this report was discussed and a copy was provided to Administrator at the conclusion of the visit.
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Anna Bueno
LICENSING EVALUATOR SIGNATURE: DATE: 09/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/19/2023
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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