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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364843157
Report Date: 10/24/2023
Date Signed: 10/24/2023 02:51:09 PM


Document Has Been Signed on 10/24/2023 02:51 PM - 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, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501



FACILITY NAME:CREATIVE EXPLORERSFACILITY NUMBER:
364843157
ADMINISTRATOR:CHEYENNE CAWLFACILITY TYPE:
840
ADDRESS:1335 W. FOOTHILL BLVD.TELEPHONE:
(909) 946-3500
CITY:UPLANDSTATE: CAZIP CODE:
91786
CAPACITY:60CENSUS: 13DATE:
10/24/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:11 PM
MET WITH:Valery Munoz/assistant director TIME COMPLETED:
03:25 PM
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On 10/24/23 at 2:11 pm, Licensing Program Analyst (LPA) Patricia Berry conducted a case management/other regarding Admission Agreement. LPA informed licensee the admission agreement will need to be revised. According to regulation 101219 (3) and (4) the admission agreement and parent handbook must indicate a 30 day prior written notice for any basic changes. LPA informed licensee to revise the admission agreement and parent handbook and send to LPA for approval by 11/7/23. LPA informed licensee once the revised admission agreement and parent handbook have been been approved, licensee will implement the changes.


Exit interview conducted with assistant director, report, appeal rights and notice of site visit provided.

Notice of site visit must be posted for 30 days.
SUPERVISOR'S NAME: Gilbert SenaTELEPHONE: (951) 782-4844
LICENSING EVALUATOR NAME: Patricia BerryTELEPHONE: (951) 782-4952
LICENSING EVALUATOR SIGNATURE:
DATE: 10/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/24/2023
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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