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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364842774
Report Date: 01/30/2026
Date Signed: 01/30/2026 11:07:48 AM

Document Has Been Signed on 01/30/2026 11:07 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: 13CENSUS: 0DATE:
01/30/2026
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:00 AM
MET WITH:Licensee, Domekia ThomasTIME VISIT/
INSPECTION COMPLETED:
11:15 AM
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On 01/30/26, Licensing Program Analyst, (LPA) Ana Rodriguez conducted a Case Management Inspection and met with Licensee Domekia Thomas. Upon arrival, LPA did not observe any day care children with the licensee.

The Department learned that on 11/03/2025, 4 children were in care at the facility with the licensee and licensee’s assistant providing care and supervision. Child #1 was seated on the living room floor while the licensee was taking the dog upstairs. When Child #1 reached toward the dog, the dog jumped and scratched Child #1 on the right side of the face. As a result, the personal rights of Child #1 was violated. The licensee provided Child #1 first aid and Child #1’s mother arrived.

Child #2 was also in the living room; however, their back was facing the incident. Child #2 heard Child #1 cry and turned around. Child #2 disclosed they asked, what happened.

Staff #1 disclosed being present during the incident; however, was on the second floor with two family members (children). Staff #1 disclosed not observing the incident but disclosed the family dog was in the backyard and the licensee was downstairs with Child #1 and Child #2.

Child #1’s guardian took Child #1 to be seen by a pediatrician. Child #1 was diagnosed with a puncture wound and dog bite. An antibiotic and pain medication was prescribed.

Interviews also revealed that the licensee’s dog is always kept on the second floor of the facility, and children do not have access to the dog. The licensee provided LPA Rodriguez with a copy of the licensee’s dog’s current vaccination records from VCA Animal Hospital.

Continue on 809C

NAME OF LICENSING PROGRAM MANAGER: Mariela Ramon
NAME OF LICENSING PROGRAM ANALYST: Ana Rodriguez
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 01/30/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/30/2026
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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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
PALMDALE CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: THOMAS FAMILY CHILD CARE
FACILITY NUMBER: 364842774
VISIT DATE: 01/30/2026
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As result of the incident, the facility was cited for violating the personal rights of Child #1 and a Type A violation has been cited. LPA Rodriguez informed licensee Domekia Thomas that this report dated 01/30/26 document a Type A citation shall be posted for 30 consecutive days as this is an immediate risk to the health, safety, or personal rights of children in care.

LPA Rodriguez informed the licensee to provide a copy of this licensing report that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

See LIC. 809 D for Deficiency



An exit interview was conducted with the Licensee. A copy of this report was provided along with the appeal rights.
NAME OF LICENSING PROGRAM MANAGER: Mariela Ramon
NAME OF LICENSING PROGRAM ANALYST: Ana Rodriguez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 01/30/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2026
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 01/30/2026 11:07 AM - It Cannot Be Edited


Created By: Ana Rodriguez On 01/30/2026 at 10:50 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 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: 01/30/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/02/2026
Section Cited
CCR
102423(a)(2)

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102423(a)(2) – Personal Rights(a) Each child receiving services from a family child care home shall be entitled... (2)To receive safe, healthful, and comfortable accommodations...
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The licensee stated her dog is no longer in her home. The licensee shall submit a written statement to the Department by (following day) explaining how she will prevent this type of incident from happening again. The statement must be emailed to LPA Ana Rodriguez at Ana.Rodriguez@dss.ca.gov.
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This requirement was not met by as evidenced by: the Department learned that on 11/03/25, Child #1 was in the living room with Child #2 when Child #1 attempted to pet the licensee’s dog. The dog reacted and scratched Child #1 on the right side of the face, leaving a diagonal scratch across the right cheek along with small red abrasions and a small puncture wound on the scalp near the hairline. This is a Type A violation that poses immediate threat to the health and safety of children 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.
Mariela Ramon
NAME OF LICENSING PROGRAM MANAGER:
Ana Rodriguez
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 01/30/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/30/2026


LIC809 (FAS) - (06/04)
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