Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 455406527
Report Date: 10/16/2015
Date Signed 10/16/2015 10:08:45 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: 6DATE:
10/16/2015
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Rebecca CrawfordTIME COMPLETED:
10:15 AM
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A visit was made to the facility in response to an application submitted by the licensee requesting an increase in capacity. The requested capacity is 14. The licensee is not the property owner. Services are provided Monday-Friday; 7am-6pm. Rebecca Crawford is the sole adult living in the home. Licensee has current pediatric CPR and 1st aid cards.

The floor and yard plan were reviewed. The garage, master bathroom, and kitchen are off limits. Sharps, cleaning supplies & chemicals (under kitchen sink), and medications (master bathroom) are stored out of the reach of the children. There is a working smoke detector, carbon monoxide detector, and fully charged fire extinguisher in the home. The home appears to be clean and orderly at this time. The licensee stated there are no weapons in the home and none were observed during this visit. The licensee stated there are not poisons in the home and none were observed. This facility does not currently provide Incidental Medical Services – IMS.

The fenced backyard serves as the outdoor play area. There is no trampoline, pool, spa, or any other body of water accessible to children.

A fire clearance approval was received 9/22/15.

The application and facility summary will be reviewed for approval.
SUPERVISOR'S NAME: Lisa McKayTELEPHONE: (530) 895-5033
LICENSING EVALUATOR NAME: Jordan MonathTELEPHONE: (530) 513-1214
LICENSING EVALUATOR SIGNATURE:

DATE: 10/16/2015
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/16/2015
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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