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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197700428
Report Date: 06/29/2020
Date Signed: 07/01/2020 03:24:22 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:THAMES FAMILY CHILD CAREFACILITY NUMBER:
197700428
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 0DATE:
06/29/2020
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Audrey ThamesTIME COMPLETED:
11:30 AM
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Licensing Program Analyst (LPA) Smith conducted a Tele-Visit with Applicant Audrey Thames, who guided analyst on a tour of the facility for a Pre licensing Inspection. COVID-19 Emergency Response Tele-Inspection call was conducted. This is a two story 4 bedroom, 3 bathroom home with kitchen/dining, living/family room, den, bonus room, laundry room and garage. Family members residing in the home include three adults, (Applicant, applicant's spouse and applicant's son). Days/hours of operation will be Monday through Sunday from 6:00AM to 5:00AM. Incidental Medical Services (IMS) policy was discussed.

Physical Plant: The home is clean and orderly. The facility entrance is through the front door. Main day care will be provided in the bonus room and den. There is a designated area for ill children as necessary in the den. There is a coat rack to hang coats and back packs on. There are age appropriate toys and play equipment. The smoke detector and carbon monoxide detector are in operable condition. LPA observed the required fire extinguisher is fully charged. The stairs are barricaded, and there are no prohibited items in the home. There are no weapon/firearms in the home. The facility sketch is complete and current, there is working telephone (cell). All poisons, medication and cleaning items are inaccessible to children. Per applicant, medication is in off limits master bedroom.

Kitchen: The following are inaccessible: Sharp items are inaccessible to children and located in a locked box in the den. No chemicals in the kitchen were observed to be accessible. The refrigerator and freezer are clean. Breakfast, lunch, snacks and dinner will be provided.

Child Care bathroom is located next to the laundry room. All mouthwash, shampoo, razors, nail polish and deodorant are inaccessible to children. Toilet and faucet are clean and operable.
SUPERVISOR'S NAME: Carissa BellTELEPHONE: (661) 202-3359
LICENSING EVALUATOR NAME: Suzanne SmithTELEPHONE: (661) 305-3012
LICENSING EVALUATOR SIGNATURE:

DATE: 06/29/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2020
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: THAMES FAMILY CHILD CARE
FACILITY NUMBER: 197700428
VISIT DATE: 06/29/2020
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Outdoor: The play area is clear and clean of debris, play area is fenced and gated all around, and there are no bodies of water on the premises. The yard is all dirt with a retaining slope on the right side of the backyard. There are no play structures at this time in the backyard.

Advisory/Other: First Aid kit was observed with supplies readily available. CPR/First Aid expire on 01/10/2021. Mandated Reporter expires on 4/3/2021. Children will nap on cots, applicant has a crib for infants. There is carpet material in the play area, and the rest of the floor in the day care area is tile. There are no prohibited items observed in the day care area. It is recommended that prohibited items not be used, as they may pose a danger to children. Windows are free from cracks, debris and insects and two set of blinds in the day care area have cords that are inaccessible to children, 6 inches from the top of the blinds.

Documents Provided and or Discussed: The following were provided (via email) to comply with Title 22 requirements: Fire Drill Log, roster, Safe Sleep poster, Social Distancing, hand washing, COVID-19 information, required postings and list of CCL forms required by each child in care. Applicant stated currently does have not child care insurance.

All adults living/residing in the home are fingerprint cleared and associated.
Application Documents: Applicant file is complete with required documentation.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, 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
SUPERVISOR'S NAME: Carissa BellTELEPHONE: (661) 202-3359
LICENSING EVALUATOR NAME: Suzanne SmithTELEPHONE: (661) 305-3012
LICENSING EVALUATOR SIGNATURE:

DATE: 06/29/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2020
LIC809 (FAS) - (06/04)
Page: 2 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: THAMES FAMILY CHILD CARE
FACILITY NUMBER: 197700428
VISIT DATE: 06/29/2020
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Any reports (documenting a Type A citation) shall remain posted for 30 days along with the Notice of Site Visit (printed out during this inspection). Failure to meet the posting requirements shall result in an immediate civil penalty. In addition, all parents of currently enrolled children and any newly enrolled child for the following 12 months shall receive a copy of report and sign the LIC 9224 acknowledging receipt. Civil Penalty assessments will be assessed if all above requirements are not adhered to.

Applicant is advised to visit www.shotsforschool.org for Immunization information.


Applicant is advised of responsibility to report suspected Child Abuse, 1-800-540-4000.
Applicant is advised for quarterly updates to contact the Child Care Advocates information: www.childcareadvocatesprogram@cdss.ca.gov

Regulation prohibits smoking of any kind of tobacco in a private residence that is licensed as a Child Care Facility and in those areas of the home where children are present (24/7 ban). State law prohibits baby walkers, bouncy seats, exersaucers and any other items that fall into that category.

Before Licensure:


Applicant and applicant son must update their TB vaccination.
Applicant, applicant spouse and applicant son provide declination of influenza.

Exit interview conducted and a copy of this report and site visit will be emailed to Applicant Audrey Thames (due to COVID-19). The read receipt is in lieu of a signature.
SUPERVISOR'S NAME: Carissa BellTELEPHONE: (661) 202-3359
LICENSING EVALUATOR NAME: Suzanne SmithTELEPHONE: (661) 305-3012
LICENSING EVALUATOR SIGNATURE:

DATE: 07/01/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/01/2020
LIC809 (FAS) - (06/04)
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