Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 455406573
Report Date: 07/05/2017
Date Signed: 07/05/2017 08:59:52 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:SISCO, CRYSTAL FAMILY CHILD CARE HOMEFACILITY NUMBER:
455406573
ADMINISTRATOR:SISCO, CRYSTALFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(530) 710-5004
CITY:REDDINGSTATE: CAZIP CODE:
96002
CAPACITY:14CENSUS: 8DATE:
07/05/2017
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
08:15 AM
MET WITH:Crystal SiscoTIME COMPLETED:
09:05 AM
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(1)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. During today's visit the home and grounds were toured and the licensee was operating within the licensed capacity. The licensee's pediatric CPR and First Aid (expire 01/31/18) cards are current. The items which could pose a danger to children (detergents, cleaning compounds, and medications) were stored out of the reach of children. Poisons are locked in a cabinet in the garage. There was a working smoke detector, carbon monoxide detector and fire extinguisher in the home. The licensee's firearms and ammunition are stored appropriately. The children use the fenced backyard as the outdoor play area. The licensee was provided a copy of A Child Care Provider's Guide to Safe Sleep. The licensee had evidence of required immunization records for herself and her assistant. Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm. All licensing reports are public information and must be made available upon request. This report was reviewed and discussed with the licensee. There were no Title 22 deficiencies cited during today's visit.
Notice of Site Visit shall be posted for 30 days from today's visit.
SUPERVISOR'S NAME: Jordan MonathTELEPHONE: (530) 513-1214
LICENSING EVALUATOR NAME: Patricia PachecoTELEPHONE: 530-895-5886
LICENSING EVALUATOR SIGNATURE:

DATE: 07/05/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/05/2017
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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