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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 192006396
Report Date: 03/27/2023
Date Signed: 03/27/2023 12:31:21 PM

Document Has Been Signed on 03/27/2023 12:31 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
MONTEREY PARK S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:THOMAS FAMILY CHILD CAREFACILITY NUMBER:
192006396
ADMINISTRATOR:THOMAS, ANNETTEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(562) 422-7177
CITY:LONG BEACHSTATE: CAZIP CODE:
90805
CAPACITY: 14TOTAL ENROLLED CHILDREN: 5CENSUS: 1DATE:
03/27/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Licensee - Annette ThomasTIME COMPLETED:
01:00 PM
NARRATIVE
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Licensing Program Analyst (LPA) R. Derraco conducted an unannounced required one year inspection to the above facility on 03/27/23. LPA arrived at the facility at 9:15 AM and met with Licensee, Annette Thomas, who guided analyst on a tour of the facility. Also present during this inspection was S2. Per Licensee, there are 5 children that are currently enrolled. There was 1 child present upon arrival.

This is a one-story home which consists of four bedrooms, two bathrooms, kitchen/dining room, living room, a detached garage, front yard and backyard (fenced). The off limit areas include three bedrooms, detached garage and front yard. Upon arrival, LPA observed that the kitchen/dining room and the living room are being remodeled. Licensee states that remodel project began approximately 2 weeks ago. Per Licensee, care is provided only in bedroom 1 until the remodel is completed. Licensee states she did not know she had to inform Department that she was making an alteration to the day care area. LPA advised Licensee that a citation under California Code of Regulation (CCR) section 102416.3(a) will be issued.

LPA observed bedroom one to have a futon couch, age appropriate toys, art supplies, board games, children reading materials, and a wall mounted television. LPA observed an outdoor porch umbrella stored in bedroom one. LPA observed the umbrella falling down into the middle of he main care area floor. LPA advised licensee that a citation under CCR section 102417(g) will be issued. The bathroom was observed to have an operable sink and toilet. Lysol disinfectant and toilet bowl cleaner were observed to be accessible on the bathroom counter top. LPA advised licensee that a citation under CCR section 102417(g)(4) will be issued. Per licensee, the backyard is currently off-limits because of the recent rain storms. The licensee states that she provides food for children in care. LPA did not observe the following items during the inspection: Infant Walkers, Johnny Jumpers, Saucer Chairs. Emergency Disaster Plan, Parent’s Rights Poster and the Facility License were observed to be posted. Smoking is prohibited in a licensed Family Child Care Home. Per Licensee, no one smokes in the home. No bodies of water were observed in the back yard
(page 1 of 3)
SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Randy Derraco
LICENSING EVALUATOR SIGNATURE: DATE: 03/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/27/2023
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 8
Document Has Been Signed on 03/27/2023 12:31 PM - It Cannot Be Edited


Created By: Randy Derraco On 03/27/2023 at 11:37 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: THOMAS FAMILY CHILD CARE
FACILITY NUMBER: 192006396

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/27/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation the licensee stored an outdoor umbrella that was not secured or mounted, in the main care area which poses a potential Health, safety and/or personal rights risk to persons in care.
POC Due Date: 04/05/2023
Plan of Correction
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Licensee will remove outdoor umbrella from the main care area and make it inaccessible to children in care.
Type B
Section Cited
CCR
102417(g)(4)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (4) Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation the licensee did not make cleaning compounds inaccessible in the bathroom designated for children in care, which poses a potential Health, safety and/or personal rights risk to persons in care.
POC Due Date: 04/05/2023
Plan of Correction
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Licensee states she will lock away cleaning compounds.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Karen Chambers
LICENSING EVALUATOR NAME:Randy Derraco
LICENSING EVALUATOR SIGNATURE:
DATE: 03/27/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/27/2023


LIC809 (FAS) - (06/04)
Page: 2 of 8
Document Has Been Signed on 03/27/2023 12:31 PM - It Cannot Be Edited


Created By: Randy Derraco On 03/27/2023 at 11:37 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: THOMAS FAMILY CHILD CARE
FACILITY NUMBER: 192006396

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/27/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102418(g)
Immunizations
(g) The licensee shall document each child's immunizations as required by the California Code of Regulations, Title 17, Section 6070, and shall maintain such documentation for as long as the child is enrolled.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview and record review, the licensee did not maintain immunization records for child in car which poses a potential Health, safety and/or personal rights risk to persons in care.
POC Due Date: 04/05/2023
Plan of Correction
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Licensee will obtain and file children's immunzation records in children's file.
Type B
Section Cited
CCR
102416.3(a)

Prior to making alterations or additions to a family child care home or grounds, the licensee shall notify the Department of the proposed changed, including, but not limited to, the following:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview and record review, the licensee did not inform the Department that she will be remodeling a part of the home that is used by childre in care, which poses a potential Health, safety and/or personal rights risk to persons in care
POC Due Date: 04/05/2023
Plan of Correction
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Licensee states she will email LPA a copy of updated facility sketch and inform LPA when project is complete to have room inspected prior to use by children in care.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Karen Chambers
LICENSING EVALUATOR NAME:Randy Derraco
LICENSING EVALUATOR SIGNATURE:
DATE: 03/27/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/27/2023


LIC809 (FAS) - (06/04)
Page: 3 of 8
Document Has Been Signed on 03/27/2023 12:31 PM - It Cannot Be Edited


Created By: Randy Derraco On 03/27/2023 at 12:01 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: THOMAS FAMILY CHILD CARE
FACILITY NUMBER: 192006396

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/27/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Section Cited
Deficient Practice Statement
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4
POC Due Date:
Plan of Correction
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4
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Karen Chambers
LICENSING EVALUATOR NAME:Randy Derraco
LICENSING EVALUATOR SIGNATURE:
DATE: 03/27/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/27/2023


LIC809 (FAS) - (06/04)
Page: 6 of 8
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: THOMAS FAMILY CHILD CARE
FACILITY NUMBER: 192006396
VISIT DATE: 03/27/2023
NARRATIVE
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play area. There are no pets on the premises.

Individuals who reside in the home were noted and discussed. Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

Licensee states that there are no firearms stored in the home. There is telephone service via a landline. Per Licensee, the home is equipped with central heating and air conditioning. The valve on the required 2A 10BC fire extinguisher indicates fully charged and was purchased in May 2022, as indicated on purchase receipt. Smoke and carbon monoxide detectors were tested and are operable.

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

The licensee has completed training on preventive health practices including Pediatric First Aid and CPR. The licensee's Pediatric First Aid and CPR expires on 05/17/24. LPA observed that the Licensee has proof of the Mandated Reporter AB 1207 compliant Child Care Training Certificate on file. Children’s records were reviewed. LPA observed that immunization records for child in care were missing. LPA advised licensee that a citation under CCR section 102418(g) will be issued. A current children’s roster was available for review.



Incidental Medical Services (IMS):
IMS was discussed with licensee. Per licensee, there are no children enrolled that require IMS at this time. 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 (page 2 of 3)
SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Randy Derraco
LICENSING EVALUATOR SIGNATURE:

DATE: 03/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/27/2023
LIC809 (FAS) - (06/04)
Page: 8 of 8
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: THOMAS FAMILY CHILD CARE
FACILITY NUMBER: 192006396
VISIT DATE: 03/27/2023
NARRATIVE
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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.

LPA advised the licensee to access forms, regulations and quarterly updates online at: www.cdss.ca.gov.

The following deficiencies listed on the attached LIC 809 (deficiency page) are being cited in accordance with California Code of Regulations Title 22. Deficiencies that are being cited need to be cleared to protect the children’s health & safety.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted, appeal rights provided, and report was reviewed with the licensee Annette Thomas.

(page 3 of 3)

SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Randy Derraco
LICENSING EVALUATOR SIGNATURE:

DATE: 03/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/27/2023
LIC809 (FAS) - (06/04)
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