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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 366423467
Report Date: 05/26/2023
Date Signed: 05/26/2023 08:38:05 AM

Document Has Been Signed on 05/26/2023 08:38 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 #5FACILITY NUMBER:
366423467
ADMINISTRATOR:DONNA WELDONFACILITY TYPE:
735
ADDRESS:33974 AVENUE "H"TELEPHONE:
(909) 918-0059
CITY:YUCAIPASTATE: CAZIP CODE:
92399
CAPACITY: 4CENSUS: 3DATE:
05/26/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:25 AM
MET WITH: Bryan Clardy-AdministratorTIME COMPLETED:
09:00 AM
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LPA Bernadette Allen conducted this Case Management visit at NEW DISCOVERY RESIDENTIAL SERVICES II, 3750 OLEANDER DR, HIGHLAND, CA 92346- Facility number 366424638 to obtain signatures on a amended copy of a 9099 originally dated and signed on 5/25/2023, regarding complaint control number COMPLAINT CONTROL NUMBER: 56-AS-20230518151907

LPA Allen requested that the administrator Bryan Clardy sign amended 9099 correcting the allegation findings from Unsubstantiated to Unfounded.

An exit interview was conducted and discussed with the administrator and a copy of the report was provided at the conclusion of the visit

SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Bernadette Allen
LICENSING EVALUATOR SIGNATURE: DATE: 05/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/26/2023
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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