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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364845576
Report Date: 07/28/2022
Date Signed: 07/28/2022 02:28:35 PM

Document Has Been Signed on 07/28/2022 02:28 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:LEAPS AND BOUNDSFACILITY NUMBER:
364845576
ADMINISTRATOR:CINDALL GREENFACILITY TYPE:
850
ADDRESS:17210 SLOVER AVENUETELEPHONE:
(909) 904-7200
CITY:FONTANASTATE: CAZIP CODE:
92337
CAPACITY: 60TOTAL ENROLLED CHILDREN: 60CENSUS: 38DATE:
07/28/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:05 PM
MET WITH:Cindall Green DirectorTIME COMPLETED:
02:15 PM
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Licensing Program Analyst (LPA) Diana Brasel arrived at the facility on a case management visit to follow-up on an unusual incident report submitted by the facility on 07/01/2022 and entered on 07/05/2022. At the time of visit, LPA toured the facility, took census, and met with Director Cindall Green, to discuss the reported incident. During the visit, LPA also conducted interviews and gathered documents.

Based on the information obtained during the visit, there appeared to be no violations of Title 22 Regulations pertaining to the reported incident.

An exit interview was held with Director Cindall Green. A Notice of Site visit was issued, along with a copy of this report. This report shall be public record for three years.
SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Diana Brasel
LICENSING EVALUATOR SIGNATURE: DATE: 07/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/28/2022
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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