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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364842774
Report Date: 02/08/2023
Date Signed: 02/08/2023 01:58:44 PM


Document Has Been Signed on 02/08/2023 01:58 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
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551



FACILITY NAME:THOMAS FAMILY CHILD CAREFACILITY NUMBER:
364842774
ADMINISTRATOR:THOMAS, DOMEKIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 404-1300
CITY:VICTORVILLESTATE: CAZIP CODE:
92394
CAPACITY:14CENSUS: 6DATE:
02/08/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Domekia Thomas, LicenseeTIME COMPLETED:
02:00 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 February 8, 2023, at 12:45 PM., Licensing Program Analyst (LPA) Kuliema Calloway made an unannounced Case Management Incident Inspection to Thomas Family Child Care Home. LPA met with Domekia Thomas who granted access to the home. At the time of LPA's arrival, there were a total of (6) day-care children present ages (2 - 4 years old) with the licensee and (2) adults.

The purpose of the Case Management Inspection was to follow up on a self reported Unusual Incident report, which was submitted to the Department on January 26, 2023. The incident report involved an allegation alleging staff 1 (S1) violated the personal rights of child 1 (C1).

During the inspection, LPA completed confidential interviews with (1) one day care child and licensee's assistant. LPA reviewed the facility records. LPA obtained the facility roster.

A safety inspection was completed where zero deficiencies were noted.

Due to the need to gather additional information, further investigation is needed.

Notice of Site Visit was given and must remain posted for 30 days.

An exit interview was conducted.

The report was discussed and left with the licensee, Domekia Thomas.
SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Kuliema CallowayTELEPHONE: (661) 202-3381
LICENSING EVALUATOR SIGNATURE:
DATE: 02/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/08/2023
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