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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 192006396
Report Date: 05/01/2024
Date Signed: 05/01/2024 11:11:18 AM

Document Has Been Signed on 05/01/2024 11:11 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 SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:THOMAS FAMILY CHILD CAREFACILITY NUMBER:
192006396
ADMINISTRATOR/
DIRECTOR:		THOMAS, ANNETTEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(562) 422-7177
CITY:LONG BEACHSTATE: CAZIP CODE:
90805
CAPACITY: 14TOTAL ENROLLED CHILDREN: 5CENSUS: 2DATE:
05/01/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Licensee - Annette ThomasTIME VISIT/
INSPECTION COMPLETED:
11:30 AM
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Licensing Program Analyst (LPA) R. Derraco conducted an unannounced case management visit to the above mentioned facility on 05/01/24. LPA arrived at the facility at 9:30 and was met by licensee, Annette Thomas, who guided analyst on a tour of the facility. LPA observed 2 children in care during inspection. No additional adults were observed in the home. The home was observed to be in compliance with Title 22 regulations.

The purpose of this visit is to confirm that licensee has received Decision and Order sent by certified mail on 04/19/24, as stated on the Declaration of Service. Licensee states that she did receive document and advised LPA that her son Cedric Thomas no longer resides in the home. LPA observed that the licensee was the only adult present during inspection. Per licensee, she was unable to open the garage door for inspection due to losing her key. Licensee states that garage is only used for storage and that the backyard play area is still off limits.

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: Denise Gibbs
LICENSING EVALUATOR NAME: Randy Derraco
LICENSING EVALUATOR SIGNATURE: DATE: 05/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/01/2024
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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