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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 366424638
Report Date: 10/23/2023
Date Signed: 10/23/2023 11:47:04 AM

Document Has Been Signed on 10/23/2023 11:47 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 IIFACILITY NUMBER:
366424638
ADMINISTRATOR:VIVIAN FRANCISCOFACILITY TYPE:
735
ADDRESS:3750 OLEANDER DR.TELEPHONE:
(909) 280-9638
CITY:HIGHLANDSTATE: CAZIP CODE:
92346
CAPACITY: 6CENSUS: 2DATE:
10/23/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:23 AM
MET WITH:Vivian FranciscoTIME COMPLETED:
11:48 AM
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) Anna Bueno made an unannounced visit to the facility to conduct a required annual inspection. LPA identified herself to direct support professional (DSP) Kayln Dirks who was advised of the purpose of the visit. DSP Dirks phoned administrator Vivian Francisco. DSP Rebecca Ring arrived shortly and Administrator Francisco arrived during the visit.

The facility is currently licensed as an Adult Residential Facility, vendored by the Inland Regional Center. The facility has capacity of four ambulatory clients. Two staff and one clients were present during the visit.

LPA Bueno and DSP Ring toured the interior and exterior of the facility. The pool is enclosed in a locked gate. The facility has shaded areas for client use. LPA observed that side gate was unlocked and free of obstruction. The facility had a working telephone for use. The facility fire extinguisher was purchased and replaced on 10/5/23. DSP tested the carbon monoxide detector and found the unit to be in working order. Administrator stated that the smoke alarms are interconnected and tested the front room smoke alarm. LPA and Administrator observed all other smoke alarms working. A locked centralized cabinet is used for medications while client and staff files and facility records are kept secured in a locked office. Sharps, toxins, and cleaning agents are kept locked in cabinets..

The following were observed of the physical plant:
Client Bedrooms and Bathroom: LPA Bueno and DSP Ring observed all bedrooms to have the required bedding and furniture, such as, clean mattresses/linen, a chair, sufficient storage space, and lighting. The facility had a supply of additional linens and towels. LPA and DSP observed bathrooms were kept in sanitary conditions and provisions for hygiene items are available.
Kitchen and Dining Areas: LPA inspected the kitchen and found dishes, glasses, and utensils were in good condition and stored in a safe manner. LPA inspected food provisions and found a 2-day supply of perishable food and 7-day supply of non-perishable food items. LPA reviewed the facility menu.
Common (living/activity) areas: LPA observed adequate seating in the common areas. LPA observed activities in the office. A calendar of activities was available for review.
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Anna Bueno
LICENSING EVALUATOR SIGNATURE: DATE: 10/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/23/2023
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
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507
FACILITY NAME: NEW DISCOVERY RESIDENTIAL SERVICES II
FACILITY NUMBER: 366424638
VISIT DATE: 10/23/2023
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
The following records were inspected:
Client Records: LPA Bueno inspected all client files and found all to have the required documentation, including but not limited to, placement and admissions agreement, current Individual Program Plan (IPP), and secured resources.
Staff Records: LPA reviewed staff files and all to have the required documentation, including but not limited to, unexpired first aid/CPR certification, DSP trainings, and criminal background clearance. LPA reviewed training and disaster drill logs.
Centralized Medication: LPA reviewed all client medications. LPA and Licensee observed all scheduled medications were administered as prescribed.

No deficiency cited during the visit. Administrator left the facility prior to the conclusion of the visit. The exit interview was conducted with DSP Ring and a copy of this report was provided.
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Anna Bueno
LICENSING EVALUATOR SIGNATURE:

DATE: 10/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2023
LIC809 (FAS) - (06/04)
Page: 2 of 2