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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 192006396
Report Date: 08/20/2025
Date Signed: 08/28/2025 08:01:45 AM

Document Has Been Signed on 08/28/2025 08:01 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: 14CENSUS: 4DATE:
08/20/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:10 AM
MET WITH:Licensee – Annette ThomasTIME VISIT/
INSPECTION COMPLETED:
12:30 PM
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On August 20, 2025, at 10:10a.m., Licensing Program Analyst (LPA) Keneisha Dunlap arrived at the above facility for the purpose of an unannounced Annual Inspection. LPA Dunlap announced the purpose of the visit and was granted entry into the facility by Licensee – Annette Thomas. There are 6 children enrolled, and 4 children present at the time of inspection. The hours of operation are Monday- Friday from 12:00a.m.-11:00p.m.

The License, Earthquake Disaster Checklist (LIC9148), Disaster Plan (LIC610A), and PUB 394 (Parent's Rights) were all observed to be posted. The Licensee maintains a current LIC 9040 (facility roster). The most recent disaster drill was conducted on January 3, 2025, and documented in the disaster drill log.

At 11:10 AM, LPA Dunlap reviewed the Licensees Disaster and Fire Drill log with a date of January 3, 2025. The Licensee was informed that Disaster and Fire Drills must be conducted every 6 months. This poses a potential health and safety risk to children in care. A Technical Violation will be issued.

This is a one-story home which consists of four bedrooms, two bathrooms, kitchen/dining room, living room, a detached garage, front yard and fenced backyard.

The off limit areas include three bedrooms, detached garage and front yard.

Bedroom (Main Care Area): This area has hardwood floors with area rug, futon couch, mounted TV, cubbies for materials, language art materials, dramatic play items, and appropriate chairs and tables. The mats are stored in this area, and children nap here also. LPA Dunlap observed all furnishings, equipment, and materials were in good condition.

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NAME OF LICENSING PROGRAM MANAGER: Karen Chambers
NAME OF LICENSING PROGRAM ANALYST: Keneisha Dunlap
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 07/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/29/2025
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 5
California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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 CARE
FACILITY NUMBER: 192006396
VISIT DATE: 08/20/2025
NARRATIVE
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Kitchen/Dining: LPA Dunlap observed the kitchen to have the knives stored on top of the cabinets, and all cabinets and drawers have safety latches and/or magnetic locks making it inaccessible to children in care.

Outdoor Play Area (Backyard): The backyard has shaded areas with large trees, toys, bikes, and age-appropriate toys, tables and chairs mini basketball hoop, scooters, and playhouse. LPA Dunlap observed all furnishings, equipment, and materials were in good condition, free of sharp, loose, or pointed parts.

Bathroom: The bathroom features an operable toilet, and sink. There are cleaning items and personal hygiene items stored in cabinets in this area with safety latches making it inaccessible to children in care.

At 11:10 AM, LPA Dunlap observed a separate cabinet with personal hygiene items. The Licensee was informed that all cleaning supplies and personal hygiene items must be stored in a locked cabinet or safety latch to make it inaccessible to children in care. LPA Dunlap observed the Licensee remove all items to an off-limits area in the home. This poses a potential health and safety risk to children in care. A Technical Violation will be issued.

Living Room: Is currently not being used due to construction.

The home currently has ventilation, but thermostat limits usage.

At 11:15AM, LPA Dunlap observed a small counter top fan. The Licensee was informed that the home must have ventilation. The Licensee informed LPA Dunlap that the HVAC thermostat is currently not working, and they are currently waiting for a handyman to come back to repair. This poses a potential health and safety risk to children in care. A Technical Violation will be issued.

An operable fire system with a pull-down alarm and siren located in the living room area.

LPA Dunlap observed 2A 10BC fire extinguisher with a service tag dated July 27, 2025, hung in the kitchen.

LPA Dunlap observed an operable smoke detector.

LPA Dunlap observed an operable carbon monoxide detector.

The Licensee confirmed the following:

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NAME OF LICENSING PROGRAM MANAGER: Karen Chambers
NAME OF LICENSING PROGRAM ANALYST: Keneisha Dunlap
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2025
LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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 CARE
FACILITY NUMBER: 192006396
VISIT DATE: 08/20/2025
NARRATIVE
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Meals are provided for children.

A landline and cell phone are used for communication.

The facility does not currently administer medication.

Sick children are isolated in the living room area.

There are no firearms in the home.

There are no smokers in the home.

Transportation is provided for children.

A first aid kit is available.

There are no large bodies of water on the premises.

There are no pets on the premises.

Staff Files



Staff #1's file contains all required licensing documents and their immunization record.

CPR certification expires on May 31, 2026.

Mandated Reporter training expires on July 25, 2027.

Children Files

Child #1's file contains all required licensing forms, and their immunization record.

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process

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NAME OF LICENSING PROGRAM MANAGER: Karen Chambers
NAME OF LICENSING PROGRAM ANALYST: Keneisha Dunlap
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2025
LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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 CARE
FACILITY NUMBER: 192006396
VISIT DATE: 08/20/2025
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Licensee – Annette Thomas was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with Licensee – Annette Thomas and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep as an additional resource. LPA also informed Licensee – Annette Thomas 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.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02- CCP. 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: https://www.ada.gov/resources/child-carecenters/.

Licensee – Annette Thomas was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

During the exit interview, the Licensee – Annette Thomas confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

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

3 Technical Violations issued during today’s visit.

Appeal rights explained and given to Licensee – Annette Thomas.

Exit interview conducted and report was reviewed with the Licensee – Annette Thomas. Page 4 of 4

NAME OF LICENSING PROGRAM MANAGER: Karen Chambers
NAME OF LICENSING PROGRAM ANALYST: Keneisha Dunlap
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2025
LIC809 (FAS) - (06/04)
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