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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 364842774
Report Date: 08/30/2023
Date Signed: 08/30/2023 01:03:18 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/10/2023 and conducted by Evaluator Kuliema Calloway
COMPLAINT CONTROL NUMBER: 12-CC-20230810094501
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: 1DATE:
08/30/2023
UNANNOUNCEDTIME BEGAN:
12:26 PM
MET WITH:Domekia Thomas, LicenseeTIME COMPLETED:
01:00 PM
ALLEGATION(S):
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Allegation: Licensee hit the day care children while in care.
INVESTIGATION FINDINGS:
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On August 30, 2023, Licensing Program Analyst (LPA), Kuliema Calloway conducted an unannounced complaint inspection to Thomas Family Child Care. LPA met with Licensee who granted access. The purpose of the inspection was to deliver findings regarding the above allegation. LPA observed 2 Staff and one infant (1) day care child.

During the investigation, LPA conducted confidential interviews with staff, parents, children, and all parties involved. Licensee denied hitting Child 1. Based on the interviews there is corroborating evidence to determine the Personal Rights allegation Licensee hit the day care children while in care is Substantiated, meaning the Preponderance of the evidence standard has been met.

There is one Type A deficiencies cited during this visit. Per Title 22 Regulations, Division 12, Chapter 1, for Personal Rights 102423 (a)(4).
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Kuliema Calloway
LICENSING EVALUATOR SIGNATURE:

DATE: 08/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
Control Number 12-CC-20230810094501
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		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 CARE
FACILITY NUMBER: 364842774
VISIT DATE: 08/30/2023
NARRATIVE
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Upon receipt of a Type A deficiency, a copy of the licensing report must also be posted for thirty (30) days. The same report must be provided to parents/guardians of children newly enrolled at the facility during the next 12 months & licensee must obtain a signed Acknowledgement of Licensing Reports (LIC 9224) from parent/guardian & place it in each child's file. Copies of the reports must be provided to each parent when a Type A violation is cited along with Acknowledgment of Receipt of Licensing Reports LIC 9224. If these requirements are not met civil penalties per violation will be assessed.

An exit interview was conducted, and a copy of this report was read, Appeal Rights and Notice of Site Visit were discussed, and provided to Domekia Thomas, Licensee. Failure to maintain posting of the Notice of Site Visit for thirty (30) consecutive days will result in a $100 Civil Penalty.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Kuliema Calloway
LICENSING EVALUATOR SIGNATURE:

DATE: 08/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 12-CC-20230810094501
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		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 CARE
FACILITY NUMBER: 364842774
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/30/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/31/2023
Section Cited
CCR
102423(a)(4)
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102423(a)(4)-(a)Each child receiving services...family child care home shall have...rights. rights include...(4) ... free from... unusual punishment, infliction of ...pain, humiliation, intimidation...threat, mental abuse...This requirement was not met as evidenced by:
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Licensee has implemented a new discipline & behavior management policy on 8/28/2023 and provided it to parents and obtained parent signatures. LPA was provided with a copy of the the new policy during the inspection.
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Based on confidential interviews the allegation on Personal Rights proved Licensee hit Child 1 while in care. This poses an immediate health, safety, or personal rights risks to the persons in care.
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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.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Kuliema Calloway
LICENSING EVALUATOR SIGNATURE:

DATE: 08/30/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 3