Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 455406527
Report Date: 05/13/2015 12:00:00 AM
Date Signed 05/13/2015 11:19:27 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., SUITE 170
CHICO, CA 95926
FACILITY NAME:CRAWFORD, REBECCA FAMILY CHILD CARE HOMEFACILITY NUMBER:
455406527
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 3DATE:
05/13/2015
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
10:50 AM
MET WITH:Rebecca CrawfordTIME COMPLETED:
11:09 AM
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(1) A visit was made to the facility by LPA, Jordan Monath. A review of staff records indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. There is presently 1 adult living in the home.

During today’s visit the home and grounds were toured and the facility was operating within the licensed capacity. Licensee stated she is normally available to provide care Monday-Friday; 7am-6pm. The floor plan was verified. The areas off limits were inaccessible (latches on doors and gate in kitchen). There is a working telephone in the home. There is a working smoke detector and fire extinguisher in the home. The licensee stated there are no weapons in the home and none were observed. The children use the fenced area behind home as the outdoor play area. Children's records were reviewed and required documents were present. The licensee has current CPR/1st aid cards (expire 2016). All licensing reports are public information and must be made available upon request for at least three years. In the areas that were evaluated, no deficiencies were observed at the time of the visit.
Notice of Site Visit shall be posted for 30 days from today's visit.
SUPERVISOR'S NAME: Lisa McKayTELEPHONE: (530) 895-5033
LICENSING EVALUATOR NAME: Jordan MonathTELEPHONE: (530) 513-1214
LICENSING EVALUATOR SIGNATURE:

DATE: 05/13/2015
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2015
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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