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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364842463
Report Date: 08/27/2019
Date Signed: 08/27/2019 03:32:03 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550
FACILITY NAME:CREATIVE MIND LEARNING CENTERFACILITY NUMBER:
364842463
ADMINISTRATOR:JANELLE TOUSSANTFACILITY TYPE:
840
ADDRESS:15089 MESA STREETTELEPHONE:
(760) 949-5300
CITY:HESPERIASTATE: CAZIP CODE:
92345
CAPACITY:22CENSUS: 9DATE:
08/27/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:25 PM
MET WITH:Sylvia Aguilar, OwnerTIME COMPLETED:
03:31 PM
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Licensing Program Analyst (LPA) Thompson-Miller met with the facility Owner/Director Sylvia Aguilar. The purpose of the inspection is to obtain information regarding a change in Director. Upon arrival LPA observed five (napping) school age children (age 5), later during the inspection four additional school age children arrived.

Ms. Aguilar provided LPA with the following:
--LIC9096 Evaluation of Director Qualifications
--Victor Valley College Transcript
--CPR/First Aid expire 04/14/2020
--LIC508 Criminal Record Statement

LPA provided the following to be submitted within 30 days:
--LIC500 Personnel Report
--LIC501 Personnel Record
--LIC503 Health Screening Report - Facility Personnel
--Preventative Health & Safety, includes Nutrition

Ms. Aguilar qualifies for the Director based upon LPA review of education qualification. Per Ms. Aguilar she will be hiring a permanent Director and will notify Licensing.

Exit interview conducted and a copy of report was read and provided to Silvia Aguilar, Owner/Director on this date.
SUPERVISOR'S NAME: Carissa BellTELEPHONE: (661) 789-6953
LICENSING EVALUATOR NAME: Linda Thompson-MillerTELEPHONE: (661) 568-8186
LICENSING EVALUATOR SIGNATURE:

DATE: 08/27/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/27/2019
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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