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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 535406302
Report Date: 06/22/2022
Date Signed: 06/23/2022 08:48:55 AM

Document Has Been Signed on 06/23/2022 08:48 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:CRUMMEY, DAVID FAMILY CHILD CARE HOMEFACILITY NUMBER:
535406302
ADMINISTRATOR:CRUMMEY, DAVIDFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(530) 739-3183
CITY:WEAVERVILLESTATE: CAZIP CODE:
96093
CAPACITY: 14TOTAL ENROLLED CHILDREN: 4CENSUS: 3DATE:
06/22/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
03:20 PM
MET WITH:David Crummey, LicenseeTIME COMPLETED:
04:15 PM
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On 06/22/22 at 3:20 p.m., an annual required inspection was made to the facility by Licensing Program Analyst (LPA), N. Cunningham. At 3:50 p.m. the outdoor play area was toured. The licensee was supervising three children, and operating within the licensed capacity and ratio requirements. The facility’s operating hours are 6:00 a.m. – 6:00 p.m., Monday–Friday. There were no pools or other bodies of water observed in the yard.

There is currently one adult living in the home. The Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

Due to a scheduling conflict, LPA was unable to complete the inspection and will return at a later date to complete the inspection. There were no deficiencies cited during today’s inspection. Exit interview conducted and report was reviewed with Licensee Crummey.

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.
SUPERVISORS NAME: Erin Virrueta
LICENSING EVALUATOR NAME: Nicolette Cunningham
LICENSING EVALUATOR SIGNATURE: DATE: 04/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/06/2022
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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