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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 367700037
Report Date: 03/03/2022
Date Signed: 03/03/2022 09:34:34 AM

Document Has Been Signed on 03/03/2022 09:34 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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:CROOMS FAMILY CHILD CAREFACILITY NUMBER:
367700037
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 5DATE:
03/03/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:35 AM
MET WITH:Brandi Crooms LicenseeTIME COMPLETED:
09:37 AM
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Licensing Program Analyst (LPA) Steven Montoya met licensee to inspect facility for Capacity Increase
(8-14) At the time of the visit, there were 2 staff (which includes licensee) and 5 infant children in care.

LPA review and discuss ratio requirements which licefnsee reports having a full understanding. License reports understanding the ratio from children to staff (Infant to staff 4:1; Toddlers 12-1).

LPA completed walk through inspection and viewed pull down fire station (BG12), which has been approved SB County Fire. LPA discuss safe sleep with licensee. Licensee reports having knowledge of infant safe sleep regulations and reviewed with LPA.

LPA reviewed report with licensee, which was signed. LPA printer was not operational at the time of the visit, LPA will print and send report to license via email by the end of the day, along with a copy of the site visit.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Steven Montoya
LICENSING EVALUATOR SIGNATURE: DATE: 03/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/03/2022
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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