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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364845578
Report Date: 08/04/2023
Date Signed: 08/24/2023 03:43:43 PM


Document Has Been Signed on 08/24/2023 03:43 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:
364845578
ADMINISTRATOR:CINDALL GREENFACILITY TYPE:
830
ADDRESS:17210 SLOVER AVENUETELEPHONE:
(909) 904-7200
CITY:FONTANASTATE: CAZIP CODE:
92337
CAPACITY:28CENSUS: 16DATE:
08/04/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Melissa Kepner TIME COMPLETED:
05:30 PM
NARRATIVE
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On this date and time, Licensing Program Analyst (LPA) Aman Sharma arrived at the facility on another matter. A case management inspection was conducted to discuss and provide the facility with regulatory information regarding Infant Needs and Services Plans.

LPA met with assistant director, Melissa Kepner, toured the facility, and took census.

During a previous inspection, an infants needs and services plan was not kept in the child's file and was not available to review by the department. LPA noted the facility was unable to provide an Infants needs and services plan. Director had stated that she had new staff who did not know they needed to keep records, and ended up throwing them away.

SEE LIC809D FOR CITED DEFICIENCIES.


Exit interview was conducted with assistant director, Melissa Kepner. A copy of this report was provided to the facility.

This report must be made available at the facility for 3 years for public review upon request.
SUPERVISOR'S NAME: Kimberly WilliamsTELEPHONE: (951) 805-5718
LICENSING EVALUATOR NAME: Aman SharmaTELEPHONE: (951) 970-7385
LICENSING EVALUATOR SIGNATURE:
DATE: 08/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/04/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2


Document Has Been Signed on 08/24/2023 03:43 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501


FACILITY NAME: LEAPS AND BOUNDS
FACILITY NUMBER: 364845578

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/04/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/07/2023
Section Cited
CCR
101419.2(d)(1)

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(d) The needs and services plan shall be included in the infant’s file.
(1) The needs and services plan shall be maintained in the infant’s file and shall be available to the Department for review.
This was not met as evidenced by:
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Facility agrees to keep an infants needs and services plan on record and made available to the department to review. Assistant director/director agrees to have a meeting with infant staff and ensure they understand the importance of needs and services plans for infants in care.
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During a previous inspection, an infants needs and services plan was not kept in the child's file and was not available to review by the department. This poses a potential risk to the health and safety of children in care.
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Assistant director/director agrees to submit POC by POC due date.

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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Kimberly WilliamsTELEPHONE: (951) 805-5718
LICENSING EVALUATOR NAME: Aman SharmaTELEPHONE: (951) 970-7385
LICENSING EVALUATOR SIGNATURE:
DATE: 08/04/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/04/2023
LIC809 (FAS) - (06/04)
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