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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197700543
Report Date: 12/12/2022
Date Signed: 12/12/2022 12:48:20 PM

Document Has Been Signed on 12/12/2022 12:48 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, 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: 1DATE:
12/12/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:20 AM
MET WITH:Andreana Thomas, LicenseeTIME COMPLETED:
12:55 PM
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On 12/12/22, Licensing Program Analyst (LPA) Justeene Tamayo met with Licensee Andreana Thomas, who guided analyst on a tour of the facility for the One Year Required inspection. This is a two story, 6 bedroom, 3 bathroom home with kitchen/dining, family room, living room, laundry room and garage. There is no pool/spa or body of water on the premises. Upon arrival LPA observed 1 infant in care. Family members residing in the home include 1 adult and 3 minor children. Facility operation are Monday-Saturday, 23 hours a day. Incidental Medical Services (IMS) policy was discussed.

Physical Plant: Main care is provided in the living room. Children use the bathroom in hallway on the right. Children have access to the living room, bedroom #1 and #2. Off limit areas include bedrooms 3-5, bathrooms #2 and #3 (upstairs), laundry room, and garage. LPA observed the main care area to be fully barricaded by a safety gate. The home was inspected inside and out for safety, clean and orderly, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents/cleaning compounds (in closet with key lock), hazardous items (sharp knives in closet with key lock) that can pose a danger to children. Per licensee she does not have any medications in the home. LPA observed a fireplace in the the living room to be fully screened. Safe and age appropriate toys, play equipment and materials were observed. The smoke detector and carbon monoxide detector, Fire Extinguisher (2A10BC) are in operable condition. Per Licensee no one smokes in the home. Electrical outlets are inaccessible. LPA reminded licensee, no baby bouncers saucer chairs, or any recalled and or prohibited toys or sleep/ play equipment are allowed. There is a designated area for ill children as necessary in the living room. Per Licensee there are no weapon/firearms in the home. The facility sketch is complete and current, there is working telephone (landline and cell).
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Justeene Tamayo
LICENSING EVALUATOR SIGNATURE: DATE: 12/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/12/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3
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: 12/12/2022
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Fire/Disaster Drill is complete and maintained current. Last Fire/Disaster Drill was completed on 11/21/22.

Roster complete and maintained current.

Bathroom: Shower/tub are free of hazards (child care bathroom). LPA did not observe any hazardous items in the children's bathroom. Toilet and faucet are clean and operable.

Kitchen: Sharp utensils, open bottles or alcohol are inaccessible. If food is brought from the children’s home, the container shall be labeled with the child’s name and properly stored or refrigerated. The home has a clean and fully stocked refrigerator/freezer. Cleaning supplies are located in the closet with a key lock. Licensee currently has a food program. Breakfast, lunch, snacks and dinner are provided. Naps are provided on cots in bedroom #1.

Outdoor: The backyard is safe for children. The backyard is completely fenced (with block cement). There is no body of water. LPA observed one outdoor air conditioner missing a cover in the backyard. Licensee will cover the second outdoor air conditioner and send a photo to LPA Tamayo for proof of completion. LPA observed age appropriate toys. Per licensee, there is one pet on the premises.

Advisory/Other: First Aid kit was observed with supplies readily available. CPR/First Aid expire 12/07/2023. Mandated Reporter expired 03/05/2022. Licensee will retake the mandated reporter training and send a copy to LPA Tamayo no later than 12/14/22. There are no window cords accessible to children.
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Justeene Tamayo
LICENSING EVALUATOR SIGNATURE:

DATE: 12/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2022
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: 12/12/2022
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Documents Provided and or Discussed: Fire Drill Log, Roster, Postings, Safe Sleep PIN 20-24-CCP, Individual Sleeping Plan (LIC9227), and Emergency Disaster Plan. Licensee stated currently does not have child care insurance.

Licensee Thomas 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.

LPA discussed the safe sleep regulations with licensee Thomas and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

A notice of site visit was given to licensee and must remain posted for 30 days.

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with the licensee Andreana Thomas, along with her appeal rights.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Justeene Tamayo
LICENSING EVALUATOR SIGNATURE:

DATE: 12/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2022
LIC809 (FAS) - (06/04)
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