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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 455407367
Report Date: 06/08/2022
Date Signed: 06/10/2022 09:41:25 AM


Document Has Been Signed on 06/10/2022 09:41 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
CCLD Regional Office, 520 COHASSET RD., SUITE 170
CHICO, CA 95926



FACILITY NAME:BROOKS, DEBRA FAMILY CHILD CARE HOMEFACILITY NUMBER:
455407367
ADMINISTRATOR:BROOKS, DEBRAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(530) 551-1281
CITY:REDDINGSTATE: CAZIP CODE:
96001
CAPACITY:14CENSUS: 2DATE:
06/08/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Debra Brooks, LicenseeTIME COMPLETED:
09:20 AM
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On June 8, 2022 at 8:45am, an annual inspection was made to the facility by Licensing Program Analyst (LPA), N. Cunningham. LPA observed the licensee providing supervision for two children. LPA was unable to complete the inspection due to the licensee's schedule. LPA will return at a later date to complete the inspection.

Exit interview conducted and report was reviewed with the licensee.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISOR'S NAME: Erin VirruetaTELEPHONE: (530) 895-4325
LICENSING EVALUATOR NAME: Nicolette CunninghamTELEPHONE: (530) 521-5235
LICENSING EVALUATOR SIGNATURE:
DATE: 06/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/08/2022
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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