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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336425826
Report Date: 09/13/2023
Date Signed: 09/13/2023 11:35:37 AM

Document Has Been Signed on 09/13/2023 11:35 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
RIVERSIDE, CA 92507
FACILITY NAME:SUPPORTING UNLIMITED POSSIBILITIES, INC.FACILITY NUMBER:
336425826
ADMINISTRATOR:STANGEL, DEBORAHFACILITY TYPE:
775
ADDRESS:14137 BUSINESS CENTER DRIVETELEPHONE:
(951) 214-6833
CITY:MORENO VALLEYSTATE: CAZIP CODE:
92553
CAPACITY: 75CENSUS: 38DATE:
09/13/2023
TYPE OF VISIT:CollateralUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Mecca Hudson-Program ManagerTIME COMPLETED:
11:40 AM
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Licensing Program Analysts (LPAs) Ryan Gardner and Javier Prieto conducted an unannounced case management visit to follow up on complaint control number 56-AS-20220518161343. LPAs met with Program Manager Mecca Hudson and explained the reason for the visit.

During today's visit, LPA Gardner interviewed one (1) client.

Based on observations today, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations.



An exit interview was conducted, and this report was discussed and provided to Program Manager Mecca Hudson.
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Ryan Gardner
LICENSING EVALUATOR SIGNATURE: DATE: 09/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/13/2023
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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