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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376105079
Report Date: 09/19/2023
Date Signed: 09/19/2023 10:30:18 AM

Document Has Been Signed on 09/19/2023 10:30 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
CCLD Regional Office, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME:THOMSEN LEARNING CENTERFACILITY NUMBER:
376105079
ADMINISTRATOR:NICOLLE DANIELSFACILITY TYPE:
830
ADDRESS:217 EARLHAM STREETTELEPHONE:
(760) 440-0014
CITY:RAMONASTATE: CAZIP CODE:
92065
CAPACITY: 12TOTAL ENROLLED CHILDREN: 12CENSUS: 11DATE:
09/19/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Nicolle DanielsTIME COMPLETED:
10:45 AM
NARRATIVE
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On 9/19/23 at 10:15am, Licensing Program Analyst, Patrick Ma and Investigator Angelica Medina met with Director Nicolle Daniels to review Plan of Correction documents remaining from 7/27/23 annual inspection. There were 11 infants present with 3 teachers in one room.

Immunizations or proof of medical appointment were originally due on 8/10/23 but an extension to 8/24/23 was granted. Staff S1 - S2 were still missing immunizations from their personnel records and facility has not provide proof of doctor's appointment to correct deficiency.

See LIC 809 for deficiency cited.

Exit interview conducted and report was reviewed with the facility representative (include name). A notice of site visit was given to licensee and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days.
SUPERVISORS NAME: Renesha Askew
LICENSING EVALUATOR NAME: Patrick Ma
LICENSING EVALUATOR SIGNATURE: DATE: 09/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/19/2023
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 09/19/2023 10:30 AM - It Cannot Be Edited


Created By: Patrick Ma On 09/19/2023 at 06:51 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
, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108

FACILITY NAME: THOMSEN LEARNING CENTER
FACILITY NUMBER: 376105079

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/19/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/31/2023
Section Cited

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ยง1596.7995(a) (1) a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles. This requirement was not met as evidenced by:
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Based on records review, facility did not have proof of immunizations on file for Staff S1 - S2, which poses a potential hazard 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.
SUPERVISOR'S NAME:Renesha Askew
LICENSING EVALUATOR NAME:Patrick Ma
LICENSING EVALUATOR SIGNATURE:
DATE: 09/19/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/19/2023


LIC809 (FAS) - (06/04)
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