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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364842774
Report Date: 05/01/2024
Date Signed: 05/01/2024 11:14:33 AM

Document Has Been Signed on 05/01/2024 11:14 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
PALMDALE CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:THOMAS FAMILY CHILD CAREFACILITY NUMBER:
364842774
ADMINISTRATOR/
DIRECTOR:		THOMAS, DOMEKIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 404-1300
CITY:VICTORVILLESTATE: CAZIP CODE:
92394
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 1DATE:
05/01/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:50 AM
MET WITH:Domekia ThomasTIME VISIT/
INSPECTION COMPLETED:
11:30 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
On May 1st, 2024, Licensing Program Analyst (LPA)Braddock, conducted an unannounced annual Inspection. LPA met with Licensee, Domekia Thomas who guided LPA on a tour of the home. People who reside in the home are (Licensee, Licensee mother (Assistant) and Adult Child) who are live scanned and have TB skin test on file and minor child (8). The large family childcare home operates 23 hours a day. Licensee was advised that a staff member must always be awake while children are in care for 23-hour operation). At the time of the visit there were 1 child present with 1 staff member.

This is a two-story home with 3 bedrooms, 2.5 bathrooms, kitchen/dining room, family room, living room, laundry room, and garage. Children have access to the kitchen, dining room, living room and half bathroom. Off-limit areas of the home are the entire upstairs, the garage and laundry. Off-limits areas are made inaccessible by safety door locks. There is not a swimming pool/body of water on the premises. LPA did observe pets at the facility. LPA observed 5 dogs which are locked behind a medal gate secured and made inaccessible to the children by 2 keypad locks. The children do not interact with dogs.

The home was inspected inside for comfort, cleanliness, telephone service, heating and ventilation. Medications are stored upstairs in the master bedroom inaccessible to children..

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Sherell Braddock
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)
Page: 1 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: 05/01/2024
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
26
27
28
29
30
31
32
 The kitchen knives are stored up high above the cabinets in a locked box and made inaccessible to children by lock box. Cleaning compounds are stored in the laundry room inaccessible to children.

The First Aid kit is located in the closet inaccessible to children by safety lock. Per licensee, there are no weapons or firearms in the home. LPA did not observe any weapons or firearms. Smoke detectors and carbon monoxide detectors are in operable condition. The Fire Extinguisher is green, fully charged, and meets the standards of the State Fire Marshal. The licensee’s Pediatric CPR/First Aid expires on 06/2025. The licensee has the required immunizations against pertussis (TDAP) and measles (MMR) and Influenza. The licensee completed the required Mandated Reporter training on 06/2025.

The required posted documents were posted and located in the entry way on the wall. Notification of Parent's Rights Poster (PUB394), Emergency Disaster Plan (LIC610A), and Earthquake Preparedness Checklist (LIC9148).

The following was discussed with the licensee:

Mandatory licensing forms for the children’s files, facility forms/records, and information to be posted in the family child care home; Requirements to conduct fire and disaster drills once every six months and record it; Role and responsibilities of being a mandated reporter were reviewed; The licensee was reminded that 100% supervision is required at all times to children in care; Licensee was made aware that it is her responsibility to know the regulations as well as anyone who assists in providing care; Licensing must have the facility’s phone number at all times; if the phone number is changed, licensing must be notified; Regulation prohibits the smoking of any kind during the operation of the day care.

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Sherell Braddock
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
LIC809 (FAS) - (06/04)
Page: 2 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: 05/01/2024
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
26
27
28
29
30
31
32
LPA discussed the safe sleep regulations with licensee 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 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.

Licensee 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.

The licensee was advised of the requirement to report Unusual Incidents. A report shall be made to the department by telephone or fax during the department's normal business hours before the close of the next working day following the occurrence during the operation of family day care home. In addition, a written report shall be submitted to the department within seven days following the occurrence of any events specified above. The licensee was informed to utilize the Unusual Incident Report/Injury Report LIC624B when submitting the report to the department.

Beginning on January 1, 2018, Assembly Bill 1207 (2015) requires all licensed providers, licensees, directors, and employees to complete training as specified on their mandated reporter duties and to renew their training every two years. Licensee must meet requirements as a precondition to licensure.

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Sherell Braddock
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
LIC809 (FAS) - (06/04)
Page: 3 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: 05/01/2024
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
26
27
28
29
30
31
32
 New employees shall have 90 days from date of employment to complete training as required. The training may be conducted at the following website www.mandatedreporterca.com.

Prior to making alterations or additions to a family childcare home or grounds, the licensee shall notify the Department of the proposed changed, including, but not limited to, the following: Conversion of a garage (either attached or detached) into a "childcare" room; Room additions to the family childcare home. Any change from an area of the family childcare home previously identified as "off limits" to an area where care and supervision will be provided to children in care. The licensee shall provide the Department with a copy of an inspection report when an inspection is required by the local building inspector as a result of the alteration, addition, or construction.

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see PIN 22-02-CCP. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514- 0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-carecenters/.

Lead Flyer Requirement Health and Safety Code 1596.7996 mandated that effective January 1, 2019, CCC's and FCCH's are required to provide parents and guardians of children enrolling or reenrolling in care with written information on the risks and effects of lead exposure, blood lead testing requirements and recommendations, and options for locations of affordable blood lead tests as specified. A Lead

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Sherell Braddock
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
LIC809 (FAS) - (06/04)
Page: 4 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: 05/01/2024
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
26
27
28
29
30
31
32
Poisoning Facts Flyer was created, in partnership with the California Department of Public Health (CDPH), to satisfy this requirement.

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.

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

The licensee was advised it is her responsibility to visit the department's website to access licensing forms, Quarterly Updates and Provider Information Notices (PINs): www.ccld.ca.gov

LPA confirmed that there are no Registered Sex Offenders living in the facility and completed the RSO profile in FAS during the file review.

This inspection visit was conducted in person. The report was read, and a copy was provided to the licensee, Domekia Thomas. Notice of Site Visit was given and must remain posted for 30 days. Exit interview was conducted.

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Sherell Braddock
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
LIC809 (FAS) - (06/04)
Page: 5 of 5