Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 455406527
Report Date: 07/12/2016
Date Signed 07/12/2016 03:26:53 PM

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:CRAWFORD, REBECCAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(530) 949-4168
CITY:REDDINGSTATE: CAZIP CODE:
96003
CAPACITY:14CENSUS: 5DATE:
07/12/2016
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
09:55 AM
MET WITH:Rebecca CrawfordTIME COMPLETED:
10:35 AM
NARRATIVE
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(2) A visit was made to the facility by LPA Patricia Pacheco. 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 are presently 2 adults living in the home.

During today’s visit the home and grounds were toured and the licensee was operating within the licensed capacity. Licensee stated normal operating hours are 6:30 am to 6:00 pm, Monday – Friday. The floor plan was verified. Off limits areas were inaccessible with use of doorknob covers, gate and latches (master bathroom, 2nd bedroom, hallway closets/laundry and kitchen). The home appeared clean and orderly. There was a working telephone in the home. The licensee has taken a course in Preventive Health Practices. The licensee's pediatric CPR and First Aid cards were current / expired. Items which could pose a danger to children (detergents, cleaning compounds, and medications) were stored out of the reach of children. Poisons were locked in garage. There was a working smoke detector, carbon monoxide detector and fire extinguisher in the home. The licensee had a current roster of children in care and provided documentation of an emergency drill being conducted within the past six months. The licensee stated no firearms and/or other dangerous weapons are kept in the home and none were observed during today's visit. The licensee stated the backyard is used by children during outdoor activity time and it was completely fenced. LPA discussed Incidental Medical Services (IMS) with licensee. All licensing reports are public information and must be made available upon request for at least three years.
Notice of Site Visit shall be posted for 30 days from today's visit.

The following violations of the California Code of Regulations, Title 22; Division 12, were observed: see LIC 809D.
SUPERVISOR'S NAME: Jordan MonathTELEPHONE: (530) 895-5948
LICENSING EVALUATOR NAME: Patricia PachecoTELEPHONE: 530-895-5805
LICENSING EVALUATOR SIGNATURE:

DATE: 07/12/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2016
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
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 HOME
FACILITY NUMBER: 455406527
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/12/2016
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/22/2016
Section Cited
102418(g)
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Immunization. Licensee shall document and maintain each child’s immunizations as long as the child is enrolled.
LPA observed that licensee does not have immunization records for Child 1 and Child 2.
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Licensee agrees to send in proof of immunization for Child 1 and Child 2 to Community Care Licensing for review.
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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: Jordan MonathTELEPHONE: (530) 895-5948
LICENSING EVALUATOR NAME: Patricia PachecoTELEPHONE: 530-895-5805
LICENSING EVALUATOR SIGNATURE:

DATE: 07/12/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2016
LIC809 (FAS) - (06/04)
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