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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376105078
Report Date: 10/12/2022
Date Signed: 10/12/2022 04:42:44 PM

Document Has Been Signed on 10/12/2022 04:42 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME:THOMSEN LEARNING CENTERFACILITY NUMBER:
376105078
ADMINISTRATOR:NICOLLE DANIELSFACILITY TYPE:
850
ADDRESS:217 EARLHAM STREETTELEPHONE:
(760) 440-0014
CITY:RAMONASTATE: CAZIP CODE:
92065
CAPACITY: 59TOTAL ENROLLED CHILDREN: 59CENSUS: 54DATE:
10/12/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Nicolle DanielsTIME COMPLETED:
02:00 PM
NARRATIVE
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On 10/12/22 at 9:45am LPA’s Patrick Ma and Selina Siao made an unannounced Case Management visit. At the facility were 54 daycare children and 6 staff in 3 rooms.

Upon review of staff and children’s records, LPA discovered some files were incomplete.

See 809D for deficiencies cited.

Exit interview conducted and report was reviewed with the facility representative Nicolle Daniels. A notice of site visit was given and must remain posted for 30 days.
SUPERVISORS NAME: Renesha Askew
LICENSING EVALUATOR NAME: Patrick Ma
LICENSING EVALUATOR SIGNATURE: DATE: 10/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/12/2022
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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Document Has Been Signed on 10/12/2022 04:42 PM - It Cannot Be Edited


Created By: Patrick Ma On 10/12/2022 at 02:38 PM
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
, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108

FACILITY NAME: THOMSEN LEARNING CENTER
FACILITY NUMBER: 376105078

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/12/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/12/2022
Section Cited
CCR
101217(a)

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101217(a) Personnel Records: The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. This requirement was not met as evidenced by:
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Director stated she will submit proof of completed documents and to the department by 11/12/22.
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Based on file review, the facility did not have LIC 503 with TB screening, Immunization records, and current Mandated Reporter certificate for Taylor Butler and Vanessa Cervantes, which poses a potential health and safety risk to 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.
SUPERVISOR'S NAME:Renesha Askew
LICENSING EVALUATOR NAME:Patrick Ma
LICENSING EVALUATOR SIGNATURE:
DATE: 10/12/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/12/2022


LIC809 (FAS) - (06/04)
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