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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197700174
Report Date: 09/14/2021
Date Signed: 09/14/2021 10:57:37 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:ALLEN, CRYSTAL FAMILY CHILD CAREFACILITY NUMBER:
197700174
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 2DATE:
09/14/2021
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME BEGAN:
09:41 AM
MET WITH:Crystal AllenTIME COMPLETED:
10:16 AM
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On 9/14/2021, Licensing Program Analyst (LPA) Carol Heath and Babatunde Ibitoye conducted an announced Pre-Licensee follow up inspection of the Allen, Crystal Family Child Care Home. LPA met with Licensee Crystal Allen. The purpose of the inspection is to conduct a follow-up Pre-Licensing Inspection to review the corrections required for licensure. LPAs and Licensee toured the facility inside and out to ensure the home meets State Licensing Title 22 Regulations.


During the time of the inspection the following corrections were observed:

· A/C unit was covered and made it inaccessible to the children

· Backyard Play equipment (Swing and Slide set) was securely be anchored according to manufacturer.



***This inspection visit was conducted in person. The report was giving to the Licensee Crystal Allen.


***As a result of this inspection, the home does meet Title 22 Regulations. The applicant is ready for licensure pending the manager's approval.
SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Carol HeathTELEPHONE: (661) 202-3709
LICENSING EVALUATOR SIGNATURE:

DATE: 09/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2021
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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