197410596-7-24-2019-30-CC-VWHY-BEDR2T-20190724123852

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197410596
Report Date: 07/23/2019
Date Signed: 07/24/2019 12:38:57 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME:	THOMAS FAMILY CHILD CARE		FACILITY NUMBER:	197410596
ADMINISTRATOR:	THOMAS, M. & JONES, D.		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(310) 738-4435
CITY:	GARDENA	STATE: CA	ZIP CODE:	90249
CAPACITY:	14	CENSUS: 0	DATE:	07/23/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	03:00 PM
MET WITH:	Mary Thomas		TIME COMPLETED:	05:15 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) V. Wheatley conducted an Annual inspection and met with the licensee at 3:30PM. The licensee is the only adult present during the inspection. The licensee's minor daughter is present. There are no day care children observed. LPA toured the areas of the child care The children will be allowed the living room, one bedroom and outdoors. The home is clean, comfortable and well ventilated. LPA observed a working smoke detector, carbon monoxide detector, charged 2A10BC fire extinguisher and working telephone. LPA observed all electrical outlets, detergents, cleaning supplies and medications are inaccessible. There are age appropriate toys and cots for napping. Licensee has current CPR, first aid, health and safety which expires March 2021. Per licensee, there are no firearms on the premises. LPA inspected the backyard which is clean. The children will use the grassy and paved areas of the backyard. LPA observed age appropriate toys. Licensee was informed to keep the windows to play house open for supervision purposes. No hazards were observed.There are no pets and no bodies of water. LPA informed the licensee in regards to Incident Medical Services in great detail and informed with regards to a written report/operation plan submitted to the department when these services are provided.

SUPERVISOR'S NAME: Sharon Greene	TELEPHONE: (424) 302-3048
LICENSING EVALUATOR NAME: Veronica Wheatley	TELEPHONE: (424) 301-3051
LICENSING EVALUATOR SIGNATURE:	DATE: 07/23/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/23/2019

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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: THOMAS FAMILY CHILD CARE	FACILITY NUMBER: 197410596
	VISIT DATE: 07/23/2019

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LPA discussed discipline policies, personal rights, civil penalties and appeal rights. LPA informed of regulations regarding reporting unusual incidents and injuries within 24 hours. In addition, licensee was informed that all adults 18 and over living or working in the home and visiting on a frequent basis must be fingerprint cleared prior to being on the premises. A minimum civil penalty will be assessed if this regulation is violated.

Licensee was informed these documents are required for all employees. The licensee will provide the following forms to the parents prior to enrollment: LIC 627 (Emergency Consent), LIC 700 (ID & Emergency), LIC 702 (Health History), LIC 613A (Personal Rights), LIC 995A (Parent's Rights), LIC 995E (Important Information for Parents), LIC 282 (Affidavit Liability Insurance). Immunization records are to be obtained from parent's prior to a child being left with provider. Immunization records shall be kept on blue cards from the local health department. Title 22 Regulations, Child Care Quarterly updates and additional information may be obtained at the department's website www.ccld.ca.gov

Licensee was informed in regards to Safe Sleep and infants must be placed on their backs when sleeping to prevent S.I.D.S. (Sudden Infant Death Syndrome). A Safe Sleep pamphlet was provided. No smoking is allowed on a day care premises. Never shake a baby to prevent Shaken Baby Syndrome. Only children eating may be in high chairs. Provider is required to wash hands after every diaper change. No baby walkers, exersauceres, jumpers and alike are prohibited. The following documents shall be posted: license, parent's rights poster, personal rights, car seat law, and emergency disaster plan. The children's roster (LIC 9040) will be kept accessible for emergency purposes.

Exit interview.

SUPERVISOR'S NAME: Sharon Greene	TELEPHONE: (424) 302-3048
LICENSING EVALUATOR NAME: Veronica Wheatley	TELEPHONE: (424) 301-3051
LICENSING EVALUATOR SIGNATURE:	DATE: 07/23/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/23/2019

LIC809 (FAS) - (06/04)

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