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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 365530236
Report Date: 01/16/2025
Date Signed: 01/16/2025 10:14:57 AM

Document Has Been Signed on 01/16/2025 10:14 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
SAN BERNARDINO ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:HILLS OF STILLMAN, THEFACILITY NUMBER:
365530236
ADMINISTRATOR/
DIRECTOR:		CHAVEZ, REGINAFACILITY TYPE:
740
ADDRESS:940 STILLMAN AVENUETELEPHONE:
(714) 363-3752
CITY:REDLANDSSTATE: CAZIP CODE:
92374
CAPACITY: 18CENSUS: 12DATE:
01/16/2025
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:07 AM
MET WITH:Administrator Regina ChavezTIME VISIT/
INSPECTION COMPLETED:
10:20 AM
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Licensing Program Analyst (LPA) Sarina Ramirez conducted an unannounced visit to the facility to initiate a complaint investigation for complaint control number 56-AS-20250114121308. LPA met with Administrator Regina Chavez, and explained the purpose of the visit.

R#1 no longer resides at the facility.

An exit interview was conducted where this report was discussed, and a copy was provided to Administrator Regina Chavez at the conclusion of the visit.
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Sarina Ramirez
LICENSING EVALUATOR SIGNATURE: DATE: 01/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/16/2025
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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