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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 192006396
Report Date: 05/10/2023
Date Signed: 05/10/2023 10:35:08 AM

Document Has Been Signed on 05/10/2023 10:35 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
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:
05/10/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Licensee - Annette ThomasTIME COMPLETED:
10:50 AM
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
Licensing Program Analyst (LPA) Randy Derraco conducted an unannounced case management visit to the above mentioned facility on 05/10/23. LPA arrived at the facility at 9:15 AM and was met by licensee, Annette Thomas, who guided analyst on a tour of the facility. LPA entered the home through a side door located on the right side of the home, past the gate leading up the driving way. LPA observed the home to be under a remodel project in the living room, dining room, kitchen, bathroom and hall ways. No additional adults were observed in home. One child was observed to be in care. The main care area was observed in bedroom 1. A door with a dead bolt lock was observed on the door leading towards the other parts of the home. LPA observed the main care area to be free of defects. The bathroom used for children in care was observed to have an operable toilet, faucet and sink. The detached garage was observed to be closed. The backyard area has been made temporarily off-limits during the remodel. Construction equipment and tools were observed stored throughout the backyard play area.

The purpose of this visit is to follow up on the Unusual Incident Report dated 05/07/23. During the visit, LPA made observations, conducted an interview with the licensee and obtained a current roster. A secondary contact number was also obtained during this inspection.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the licensee Annette Thomas.

SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Randy Derraco
LICENSING EVALUATOR SIGNATURE: DATE: 05/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/10/2023
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