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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197700543
Report Date: 12/22/2021
Date Signed: 12/24/2021 09:06:54 AM

Document Has Been Signed on 12/24/2021 09:06 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:THOMAS FAMILY CHILD CAREFACILITY NUMBER:
197700543
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
12/22/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
01:41 PM
MET WITH:Andreana ThomasTIME COMPLETED:
04:20 PM
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On 12/22/2021, Licensing Program Analysts (LPAs) Carol Heath conduct an Pre-Licensing inspection with The applicant, Andreana Thomas to ensure the facility meets basic licensing requirements set forth by Title 22, Health and Safety and statutory requirement. The applicant is requesting to provide care for a Small family childcare home for the capacity of 8 children. Currently, there are 1 adult (The applicant) and 4 children (14 yrs, 12 yrs, 7yrs and 2 years old) living in the home. LPA toured the home indoor and out to ensure it meets FCCH requirements. The applicant is requesting the days and hours of operation will be Monday through Saturday 23 hours.

The home is described as follows:

This is a Two-story home consists of 6 bedrooms, 3 bathrooms, kitchen, living room, Dinning Room, laundry room, garage, and backyard. The off-limits areas: include all second floor bedrooms (Master bathroom #3, Bedroom #4, #5 and #6), Downstair bedroom #2 (Office), laundry room, Kitchen and the garage. The home has central heating and air conditioning. All windows are free of cracks, bugs and debris. Hanging window blinds are cordless are inaccessible to the children.


Indoor:
· Main area: Main care is provided in the Playroom 1 and Playroom 2 area. Children use the bathroom in the hallway. Children have access to the backyard.
Playroom 1 (Bedroom #1): In the Bedroom #1, LPA observed age-appropriate toys and furniture for the children such kitchen set, 2 small table and chairs.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Carol Heath
LICENSING EVALUATOR SIGNATURE: DATE: 12/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/22/2021
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: THOMAS FAMILY CHILD CARE
FACILITY NUMBER: 197700543
VISIT DATE: 12/22/2021
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Playroom 2 (TV room): The Playroom 2 area is next to the kitchen. Per the applicant, this is her isolation area for ill or sick children. LPA observed a couch and TV for children. LPA observed a small table with a 4 chairs, play mat, books and other materials.
Bathroom #1: Children will use the bathroom #1 down the hall across from the playroom #1 .The bathroom #1 was toured, and inspected medicine cabinet/toilet are in operable condition. Toilet and faucets are clean, safe, and operable; bathtub and shower area free of hazard. No medications storage in the medicine cabinet.
Outside: The backyard was inspected. The backyard is completely surrarred by a fence. There are several items of toys (swing sets with slice) available for the children that was observed in the backyard without the anchors. Children are able to play in the backyard. There are multiple small play structures in the yard. LPA observed a large trampoline. LPA shared the requirement with the applicant such as age and safety.
· Off-limit area:
Kitchen: The All sharp utensils, cutlery, cleaning supplies, medicines; drawers and cabinets with plastic bags, and sharp things or small things children can swallow; are inaccessible to children with child safety gate (The applicant ordered the gate). The refrigerator dishwasher, stove, microwave, etc., are clean. The kitchen was clean, orderly, and free of hazardous items.
Bedrooms (upstairs) with a safety gate: Master bedroom #3, Bedroom #4, #5 and #6
Bedroom #2 (Office): LPA observed the Bedroom #2 (Office). The room will need to have a
safety lock to make the room inaccessible to the children.
Bathroom #2 (Master Bathroom) and Bathroom #3: The bathrooms were toured, and inspected medicine cabinet/toilet is in operable condition.
Laundry room: The clean supplies and poison are in the laundry room. There is no safety lock which made accessible to children.
Garage: LPA inspected the garage. According to The applicant, the garage is off-limit for the children with the safety door lock.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Carol Heath
LICENSING EVALUATOR SIGNATURE:

DATE: 12/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/22/2021
LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: THOMAS FAMILY CHILD CARE
FACILITY NUMBER: 197700543
VISIT DATE: 12/22/2021
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· Other:
Napping equipment (cots): LPA observed 13 napping equipments. Per applicant, the children will nap on cots in the Playroom #2 with adult supervision.
Electrical outlets: All unused electrical outlets are plugged in and made inaccessible to children.
The First Aid kit is located in downstair closet near the front door inaccessible to children.
Weapons or Firearms: Per The applicant, there are no weapons or firearms. LPA did not observe any weapons or firearms.
Cleaning compounds are stored away in the laundry area (Second Floor) inaccessible to children
A smoke detector and a carbon monoxide detector tested operable.
Fire extinguisher (2A10BC) There is a fully charged fire extinguisher (2A10BC); which meets fire marshal standards.
Incidental medical Services (IMS): According to the applicant, she will Not provide the IMS to the children. LPA shared the information and website for the applicant.
Pet: 2 small dogs are in this facility.
· Documentation:
A The applicant has current CPR, First Aid Training with the expiration dates of 12/2023, and Prevented Health and Safety Training completed: 12/10/2021. The applicant has her fingerprint clearance and TB exam. The applicant has proof of being immunized against influenza, pertussis, and measles. The applicant has proof of Mandated Reporting Training dated 03/5/2020. Per applicant, she will provide transportation. Per The applicant meals and snacks will be provided for children.
The following was discussed with The applicant:
Mandatory Forms for the children’s files and provider’s files, Requirements for fire drills, earthquake drills, and documentation for both. Role and responsibilities of being a mandated reporter. The applicant reminded that 100% supervision is required at all times to children in care. The applicant was advised how to access forms and Regulations for Family Child Care online at www.ccld.ca.gov. The applicant was made aware that it is he/her responsibility to know the regulations as well as anyone who assists in providing care. Licensing must have the facility’s phone number at all times; if the phone number is changed, licensing must be notified
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Carol Heath
LICENSING EVALUATOR SIGNATURE:

DATE: 12/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/22/2021
LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: THOMAS FAMILY CHILD CARE
FACILITY NUMBER: 197700543
VISIT DATE: 12/22/2021
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The regulation prohibits the smoking of tobacco in a private residence that is licensed as a family childcare home and in those areas of the family day care home where children are present (24/7 ban). State law prohibits baby walkers, bouncy seats, exersaucers, and any other items that fall into that category.
·On January 1, 2018, or before March 30, 2018, a person who is a licensed childcare provider, administrator, or employee of a licensed child day care facility shall complete the online mandated reporter training and shall complete renewal mandated reporter training every two years. @www.mandatereporterca.com

**Senate Bill AB 633 - Child Care Facilities: Parent Notification Requirements
Summary: This bill amends Health and Safety Code (HSC) sections 1596.859, 1596.8595, 1596.8895, and 1597.05 to improve the transparency of licensing records and to ensure that parents/guardians using a licensed childcare facility are aware of situations that present the greatest danger to children.

Each report (documenting a Type A citation) shall remain posted for 30 days along with the Notice of Site Visit (printed out during this inspection). Family childcare homes shall post during hours of operation. Failure to meet the posting requirements shall result in an immediate $100.00 civil penalty In addition; all parents of currently enrolled children and any newly enrolled child for the following 12 months shall receive a copy of report and sign the LIC 9224 acknowledging receipt. Civil Penalty assessments will be assessed if all above requirements are not adhered to.

§1597.622 Employees or volunteers at family day care home; immunization requirements; records; exemptions (1) Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year

SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Carol Heath
LICENSING EVALUATOR SIGNATURE:

DATE: 12/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/22/2021
LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: THOMAS FAMILY CHILD CARE
FACILITY NUMBER: 197700543
VISIT DATE: 12/22/2021
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**Incidental medical Services (IMS) policy was discussed. The applicant will wait until facility opens to determine IMS needs. 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

·Safe Sleep in Child Care: Resources can be found on our website at http://www.cdss.ga.gov/inforesources/Child-Care-Licensing/Public-Information-and-Resources/Safe-Sleep

Lead Poisoning: For more information, go to the California Childhood Lead Poisoning Prevention Branch’s website at www.cdph.ca.gov/programs/clppb,or call them at (510) 620-5600.

The applicant advised visit www.shotsforschool.org for Immunization information.



Child Care Advocates: You can now sign up for Quarterly Updates and PINs for one or more programs through our DSS website at www.ccld.ca.gov. Click on “Receive Important Updates” located in the right middle part of the page, immediately above the Quick links. Put your email address and choose which program(s) you would like to subscribe to and click “subscribe”.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Carol Heath
LICENSING EVALUATOR SIGNATURE:

DATE: 12/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/22/2021
LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: THOMAS FAMILY CHILD CARE
FACILITY NUMBER: 197700543
VISIT DATE: 12/22/2021
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Prior to being licensed the follow is required by: Due 12-23-2020.
Office needs to make inaccessible to children.
Laundry room needs to make inaccessible to children.
 Family room and Dinning area need to make it inaccessible to children
 AC units need to make it inaccessible to children
 The backyard play equipment needs to be anchored


**As a result of this inspection, the home does not meet Title 22 Regulations. Corrections are required.


An exit interview was conducted and the report was reviewed with the facility representative Andreana Thomas
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Carol Heath
LICENSING EVALUATOR SIGNATURE:

DATE: 12/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/22/2021
LIC809 (FAS) - (06/04)
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