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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197492956
Report Date: 09/17/2021
Date Signed: 09/17/2021 09:57:35 AM

Document Has Been Signed on 09/17/2021 09:57 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:THOMASON FAMILY CHILD CAREFACILITY NUMBER:
197492956
ADMINISTRATOR:HALSTEAD, JENNIFERFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 557-4696
CITY:LANCASTERSTATE: CAZIP CODE:
93536
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 5DATE:
09/17/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:25 AM
MET WITH:Jennifer NavarreteTIME COMPLETED:
10:00 AM
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Licensing Program Analyst (LPA) Lady King-Lewis conducted a case management inspection to conclude the follow up on an unusual incident report received on 05/24/2021. LPA met with Licensee's assistant Jennifer Navarrete. Upon arrival, there were 5 children and 1 staff present today at the facility. All staff at the facility are fingerprint cleared.

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

The follow up on the unusual incident was conducted by LPA Monique Ayala and the Department's Investigator Douglas Real. The unusual incident follow- up consisted of interviews conducted with children, staff, parents, including, but not limited to review of the facility video surveillance. Based on an evaluation of the information obtained, no regulation was violated, and no deficiency is being cited in relation to this incident.
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Lady King
LICENSING EVALUATOR SIGNATURE: DATE: 09/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/17/2021
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: THOMASON FAMILY CHILD CARE
FACILITY NUMBER: 197492956
VISIT DATE: 09/17/2021
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Licensee is encouraged to continue to report unusual incidents.

An exit interview was conducted, and a copy of this report was provided to the licensee's assistant along with Notice of Site Visit.
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Lady King
LICENSING EVALUATOR SIGNATURE:

DATE: 09/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2021
LIC809 (FAS) - (06/04)
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