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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376629111
Report Date: 09/27/2021
Date Signed: 10/14/2021 06:55:53 AM

Document Has Been Signed on 10/14/2021 06:55 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:THOMAS, JAZMINE FAMILY CHILD CAREFACILITY NUMBER:
376629111
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 14CENSUS: 6DATE:
09/27/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:05 PM
MET WITH:Jazmine ThomasTIME COMPLETED:
12:30 PM
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On 09/27/21 at 12:05 am, Licensing Program Analyst (LPA) Adrian Castellon conducted an announced capacity increase inspection with licensee Jazmine Thomas. Purpose of the visit is to ensure that licensee Thomas has completed corrections per last inspection dated 08/30/21 so that a large license capacity 14 may be issued A fire clearance report dated 08/17/21 was received by the SDRO. Licensee Thomas will use the following areas for child care: living room, dining area, daycare room and hallway bathroom. Off limits areas include: second floor (staircase is properly barricaded via babygate) and the laundry room which is properly secured. Licensee will utilize the front, back and side yards for outdoor activities. There are no bodies of water observed during time of visit. Licensee states that there are no firearms in the home. The fire extinguisher, carbon monoxide detector and smoke detector meet requirements and are operational. There are 6 children present along with a cleared assistant.

Prior to a large license being issued, the backyard must be cleared of landscaping items (bricks, pieces of wood with screws, and other construction materials an items. This has been completed.

A large license may be issued aftr a final file review. No citations issued on this date.

SUPERVISORS NAME: Cynthia Gray
LICENSING EVALUATOR NAME: Adrian Castellon
LICENSING EVALUATOR SIGNATURE: DATE: 09/27/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/27/2021
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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