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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 397005660
Report Date: 09/17/2021
Date Signed: 09/17/2021 10:46:27 AM

Document Has Been Signed on 09/17/2021 10:46 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, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME:NEW VISION SERVICES INC. SOUTHFACILITY NUMBER:
397005660
ADMINISTRATOR:TANYA SLOANFACILITY TYPE:
735
ADDRESS:702 SCOOTER WAYTELEPHONE:
(209) 851-8591
CITY:STOCKTONSTATE: CAZIP CODE:
95209
CAPACITY: 6CENSUS: 5DATE:
09/17/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:55 AM
MET WITH:Tanya Sloan, AdministratorTIME COMPLETED:
10:30 AM
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LPA Bruce Jacobs received an incident report from the facility and conducted a follow-up/investigation. Licensing received an Incident Report from the facility of an altercation between a staff and resident with the initial report indicating the resident was the aggressor. During a follow-up review of the incident by the facility, the resident stated he was struck during the altercation

LPA interviewed the staff involved in the incident who provided additional information. The client has since moved in with his family and will likely not returned to the home. The client was interviewed by the Valley Mountain Regional Center as were other clients as well. The client provided information that was not consistent and other clients in the home did not corroborate the client (C-1) details. All staff interviewed denied any intentional or even incidental contact with the resident. The facility working the Regional Center to assess the client and determine on going placement plan.

LPA determined that was not sufficient information to prove with a preponderance of evidence that staff had either intentional or accidentally struck a client. No deficiencies were issued on this visit.
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Bruce Jacobs
LICENSING EVALUATOR SIGNATURE: DATE: 09/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/17/2021
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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