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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198400649
Report Date: 10/13/2022
Date Signed: 10/13/2022 03:51:23 PM

Document Has Been Signed on 10/13/2022 03:51 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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:THOMAS FAMILY CHILD CAREFACILITY NUMBER:
198400649
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
10/13/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Cleo ThomasTIME COMPLETED:
04:00 PM
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Licensing Program Analysts (LPAs) Elka Chavez and Patricia Medel conducted a pre-licensing inspection for the above address on October 13, 2022. LPAs arrived at 12:30 PM, and met with Cleo Thomas, Applicant, who guided LPAs on a tour of the facility. This is a change of location inspection with the Applicant previously licensed at 334846135. During this inspection individuals who reside in the home were discussed and noted. The applicant is requesting a small family child care home license. Per Applicant, child care will be provided at all hours of the day from Monday through Friday and Saturday 6:00 AM to 5:00 PM. Applicant understands that care for a child should not exceed 24 hours. Applicant states that she will care for children from birth to 17 years of age.

This is a two-story home. The home consists of 5 bedrooms, 2 1/2 bathrooms, living room, dining room, kitchen, play room, front yard, play area in the backyard (fenced), backyard (fenced), detached garage and pool house. The home was inspected for safety, comfort, cleanliness, landline and cellular service, central air and heating.



Areas used by children include: Living room, bedroom 1 located next to the front door, play room, bathroom next to the play room, kitchen, dining room, living room, play area next to the kitchen in the backyard (fenced). LPA indicated that all outdoor play will require 100% supervision.
Areas off limits include: Bedrooms 2 to 5, bathroom next to bedrooms 2 and 3, second floor, pool area (fenced), detached garage, pool house and front yard.

The applicant understands that licensing staff may have access to off-limit areas during inspection visit if necessary. ** Rooms that are off-limits need to be made inaccessible during operating hours** LPAs observed the door leading to bedroom 2 to 3 is kept locked. At 1:10 PM LPAs observed knives are kept in a knife safe with a lock in the kitchen. Shampoos, lotions, disinfectants, detergents, or any item that could be a hazard are inaccessible. LPAs observed they are kept in the off-limit bedroom hallway cabinet.

SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Elka Chavez
LICENSING EVALUATOR SIGNATURE: DATE: 10/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/13/2022
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: THOMAS FAMILY CHILD CARE
FACILITY NUMBER: 198400649
VISIT DATE: 10/13/2022
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Applicant has completed the required Pediatric First Aid and CPR. Applicant has proof of Health and Safety Training with one hour of nutrition and one hour of lead training included. Applicant has proof of immunization against pertussis and measles, influenza and proof of Mandated Reporter Training on file.

The required postings were observed next to the side entrance. Applicant states she will provide food for children in care. Applicant was advised to properly label and store children's food if brought from home. LPAs observed age appropriate toys and learning materials. The required (2A10BC) fire extinguisher was observed in the living room. LPAs did not observe a service tag. LPAs observed a service receipt from Advance Fire Extinguisher Co. LPAs observed the First Aid kit is kept in the play room.

Per Applicant, there are no weapons or firearms in the facility, none were observed by LPAs. There are no pets in the facility. The home is clean and orderly, there are outlet covers throughout the home. Smoke detector and carbon monoxide detector were observed, tested and are in operable condition. LPA observed them in the living room and play room. LPAs heard the test alarm turn on. LPAs observed the pool is surrounded by a mesh fence. LPAs observed the fence to be in good repair. The fence is constructed so that it does not obscure the pool from view. LPAs observed the fence to be at least 5 feet high, the bottom of the fence is no more than 4 inches from the ground and horizontal railings are at least 4 inches apart. The fence is constructed so that children are not able to climb it. LPAs observed the gate swings away from the pool, self-closes and self-latches. LPAs observed the fence is kept locked. LPAs observed the pool area can be accessed through the play room. LPAs observed a sliding door with a child proof sliding door lock bar with anti-lift lock. LPAs observed ADT exit and entry motion detector located in the play room. LPAs observed the detector alert applicant when the door is opened.

Per Applicant parents will drop off/pick up at the side entrance. Daily temperature checks and health screenings will be done at the entrance. Per Applicant, highly touched areas, bathroom and toys will be disinfected at the end of the day or as needed. Per Applicant children will be encouraged to wash their hands for 20 seconds throughout the day as needed. Per Applicant personal items will be placed in an individual cubby. Children will be provided their own blanket and sheet for nap. Bedding will be washed weekly or as needed by the parents. The isolation area for a sick child waiting to be picked up will be in dining room away from other children. LPAs advised applicant to ensure they are following the guidance from the local health authorities to prevent and reduce the transmission of diseases.
SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Elka Chavez
LICENSING EVALUATOR SIGNATURE:

DATE: 10/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2022
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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: THOMAS FAMILY CHILD CARE
FACILITY NUMBER: 198400649
VISIT DATE: 10/13/2022
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Applicant, Cleo Thomas was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, 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 applicant, Cleo 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 applicant, Noe Guerrero 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.

This facility plans to provide Incidental Medical Services – IMS. For IMS information, see PIN 22-02-CCP. 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

LPA reviewed with applicant, Cleo Thomas the LIC 311D, Forms/Records to Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted. Entrance Checklist was provided to the applicant.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform.
To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.
SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Elka Chavez
LICENSING EVALUATOR SIGNATURE:

DATE: 10/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2022
LIC809 (FAS) - (06/04)
Page: 3 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: THOMAS FAMILY CHILD CARE
FACILITY NUMBER: 198400649
VISIT DATE: 10/13/2022
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At this time, applicant is in compliance with California Title 22 Regulations. After further review by the department, applicant will be notified if/when License is granted. Once licensed, the applicant is required to adhere to the terms and limitations as stated on the license.

Exit interview conducted and report was reviewed with the applicant, Cleo Thomas.
SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Elka Chavez
LICENSING EVALUATOR SIGNATURE:

DATE: 10/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2022
LIC809 (FAS) - (06/04)
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