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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 483010129
Report Date: 01/09/2023
Date Signed: 01/09/2023 01:24:16 PM

Document Has Been Signed on 01/09/2023 01:24 PM - 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, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:CLEVELAND, CRYSTAL FCCHFACILITY NUMBER:
483010129
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 5DATE:
01/09/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Crystal ClevelandTIME COMPLETED:
01:45 PM
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Licensing Program Analyst (LPA) Glenn Ouye met with licensee Crystal Cleveland for a capacity increase case management visit. The licensee is going from a small FCCH to a large FCCH. The application was received by the department on December 12, 2022.

The facility has a functioning smoke and carbon monoxide detector. The is also a fire extinguisher rated at 2A10BC. The licensee installed a pull station fire alarm hear the rear sliding glass door.

The licensee conducts disaster drills at least every six months.

The facility/licensee is approved as a large family child care home effective today, January 9, 2023.
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Glenn Ouye
LICENSING EVALUATOR SIGNATURE: DATE: 01/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/09/2023
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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