<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197492956
Report Date: 05/28/2021
Date Signed: 05/28/2021 04:21:58 PM

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:THOMASON FAMILY CHILD CAREFACILITY NUMBER:
197492956
ADMINISTRATOR:HALSTEAD, JENNIFERFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 557-4696
CITY:LANCASTERSTATE: CAZIP CODE:
93536
CAPACITY:14CENSUS: 10DATE:
05/28/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Jennifer Thomason, LicenseeTIME COMPLETED:
04:30 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
On May 28, 2021, Licensing Program Analyst (LPA) Monique Ayala conducted a case management inspection to follow up on an Unusual Incident reported to the department by telephone and email on 05/24/2021; this incident was reported timely. LPA spoke with licensee. LPA toured the facility and took a census of the children. Upon arrival, there were 10 children and 3 staff present today at the facility. All staff at the facility are fingerprint cleared.

Description of the incident: An incident on 05/24/2021 at approximately 5:30pm, child #1 had inappropriate conduct with child #2.

LPA interviewed children, interviewed staff, reviewed and obtained video footage, obtained images of facility and obtained a copy of the facility roster.

A final determination has not been made and further follow up is needed. No citations are being issued on this date. This Unusual Incident was reported timely to the Palmdale Regional Office.

An exit interview was conducted and a copy of this report was provided to the licensee along with Notice of Site Visit.
SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 369-2168
LICENSING EVALUATOR NAME: Monique Jessica AyalaTELEPHONE: (661) 202-3365
LICENSING EVALUATOR SIGNATURE:

DATE: 05/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/28/2021
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 1