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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 361881207
Report Date: 06/21/2023
Date Signed: 06/21/2023 04:52:46 PM

Document Has Been Signed on 06/21/2023 04:52 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
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:GIFTED HOMES IFACILITY NUMBER:
361881207
ADMINISTRATOR:CREER, KEDRAFACILITY TYPE:
735
ADDRESS:13339 MEDICINE BOW CTTELEPHONE:
(323) 395-8594
CITY:VICTORVILLESTATE: CAZIP CODE:
92394
CAPACITY: 5CENSUS: 3DATE:
06/21/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:57 PM
MET WITH:Patricia Woods-AdministratorTIME COMPLETED:
04:55 PM
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On 6/21/23 at 2:57 PM, Licensing Program Analyst (LPA) Michelle Echeverria conducted an announced visit to the facility for the purpose of approving the facility's request of a capacity increase. LPA was greeted and granted entrance by the Administrator, Patricia Woods.

Per the LIC200, Licensee, Kedra Creer requested a capacity increase from 5 to 6 on 05/28/2023. The fire clearance request was approved on 06/20/2023 for four (4) ambulatory and two (2) non-ambulatory. There is a facility sketch on file with designation of capacity for each room.

During today’s visit, LPA toured the facility and inspected bedrooms #1, #2, #3, #4 and #5. LPA observed that bedrooms #1, #2, #3, #4 and #5 were in good repair and had the required furniture. LPA observed bedroom # 1 with an exit door leading directly outside of the facility. The physical plant is ready for a capacity increase. LPA will update the facility's file and issue a new license stating change in capacity.

No deficiencies were cited during this visit. An exit interview was conducted where this report LIC809 was discussed and provided to the Administrator, Patricia Woods.

SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Michelle Echeverria
LICENSING EVALUATOR SIGNATURE: DATE: 06/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/21/2023
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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