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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 547206879
Report Date: 12/16/2024
Date Signed: 12/16/2024 11:27:54 AM

Document Has Been Signed on 12/16/2024 11:27 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, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME:DISCOVERY IN THE WESTFACILITY NUMBER:
547206879
ADMINISTRATOR/
DIRECTOR:		ALLEN, TARAFACILITY TYPE:
735
ADDRESS:12143 AVENUE 322TELEPHONE:
(559) 372-8470
CITY:VISALIASTATE: CAZIP CODE:
93291
CAPACITY: 4CENSUS: 2DATE:
12/16/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:30 AM
MET WITH:Tara Allen, Administrator (ADM)
Leah Martinez, Program Liason Quality Assurance
Development (PLAD)		TIME VISIT/
INSPECTION COMPLETED:
11:32 AM
NARRATIVE
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On 12/16/24, Licensing Program Analyst (LPA) L. Salazar arrived at the facility unannounced to conduct a case management based on self reporting incident received on 10/14/24. LPA was greeted by Administrator, stated the purpose of the visit and was allowed entry.

LPA observed 1 out of 2 residents in care at the time of the visit. During a medication audit, Administrator identified a medication error by Staff S1 on a routine medicine (Ferrous Sulfate) for Resident R1. S1 gave R1 the medication daily for 3 days instead of 3 times a week. Administrator contacted the Physician Assistant to report the error. Facility put R1 on increased monitoring per PA. No adverse reactions were observed.

Based on observation and record review, the licensee failed to ensure medication was given as prescribed by the doctor in 1 out of 2 residents, which poses a potential risk to residents in care. Per California Code of Regulations, Title 22, Division 6, Chapter 8, a deficiency is being cited on the attached 809-D. The plan of correction has already been cleared prior to LPA arrival.

An exit interview was conducted. A copy of this report and appeal rights were provided at the time of visit.

SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Lisa Salazar
LICENSING EVALUATOR SIGNATURE: DATE: 12/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/16/2024
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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Document Has Been Signed on 12/16/2024 11:27 AM - It Cannot Be Edited


Created By: Lisa Salazar On 12/16/2024 at 10:54 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: DISCOVERY IN THE WEST
FACILITY NUMBER: 547206879

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/16/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/17/2024
Section Cited
CCR
80065(a)

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80065 Personnel Requirements
(a) Facility personnel shall be competent to provide the services necessary to meet individual client needs and shall, at all times, be employed in numbers necessary to meet such needs. This requirement was not met as evidenced by LPAs observation of facility's reporting of a medication error.
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Administrator removed S1 from the staff schedule for medications until additional training was provided 10/24/24, (7-days later). An additional staff member has been assigned for med disbursement to assure correct dosages are given.
**POC cleared**
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Staff S1 dispensed medication for R1 incorrectly. S1 dispersed R1's medication every day for 3 days instead of 3 times a week. If not corrected this poses a potential risk to residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Melinda Hoffmann
LICENSING EVALUATOR NAME:Lisa Salazar
LICENSING EVALUATOR SIGNATURE:
DATE: 12/16/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/16/2024


LIC809 (FAS) - (06/04)
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