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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 364842774
Report Date: 12/02/2024
Date Signed: 12/02/2024 02:29:40 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
PALMDALE CC RO, 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
09/13/2024 and conducted by Evaluator Sherell Braddock
PUBLIC
COMPLAINT CONTROL NUMBER: 12-CC-20240913124714
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: 4DATE:
12/02/2024
UNANNOUNCEDTIME BEGAN:
01:51 PM
MET WITH:Domekia ThomasTIME COMPLETED:
02:40 PM
ALLEGATION(S):
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Licensee allowed an unlceared adult to reside in the home.
INVESTIGATION FINDINGS:
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On December 2nd 2024, Licensing Program Analyst (LPA) Braddock made an unannounced inspection to the Thomas Family Child Care. The purpose of the visit was to deliver findings regarding the above allegation. LPA met with Domekia Thomas who granted access. LPA observed 4 children and 2 staff in care.

During the investigation, LPA conducted confidential interviews, reviewed facility files and records, obtained documents pertinent to the investigation, and toured the entire facility. . Based on the interviews with staff, children, parents, and all parties involved, the evidence corroborates with the allegation licensee allowed uncleared adult to reside in the home. meaning the Preponderance of the evidence standard has been met.

There is one Type A deficiency cited during this inspection. Per Title 22 Regulations, Division 12, Chapter 1, Criminal Record Clearance 102370(d)(e). See 9099 D page.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Sherell Braddock
LICENSING EVALUATOR SIGNATURE:

DATE: 12/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2024
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-20240913124714
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
PALMDALE CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: THOMAS FAMILY CHILD CARE
FACILITY NUMBER: 364842774
VISIT DATE: 12/02/2024
NARRATIVE
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Upon receipt of a Type A deficiency, a copy of the licensing report must also be posted for 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 were discussed, and a Notice of Site Visit, and a copy of all forms mentioned were provided to the Licensee Domekia Thomas. A Notice of Site Visit must remain posted for 30 days. Removal of the posting is subject to a $100 civil penalty.

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Sherell Braddock
LICENSING EVALUATOR SIGNATURE:

DATE: 12/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 12-CC-20240913124714
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
PALMDALE CC RO, 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: 12/02/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/02/2024
Section Cited
CCR
102730(d)
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(d) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing, or volunteering in a licensed facility:
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Licensee states there will not be any uncleared adults at the facility
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This requirement was not met as evidenced by: Licensee allowed an adult who is not associated to the facilty be enter the facility or engage with child care children.
This poses an immediate health, safety, or personal rights risk to persons in care
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Type A
12/02/2024
Section Cited
CCR
102730(e)
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Violation of Section 102370(d) will result in a citation of a deficiency and an immediate assessment of civil penalties of one hundred dollars ($100) per violation per day for a maximum of five (5) days by the Department.
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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: Lady King
LICENSING EVALUATOR NAME: Sherell Braddock
LICENSING EVALUATOR SIGNATURE:

DATE: 12/02/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3