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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197700349
Report Date: 06/28/2022
Date Signed: 06/28/2022 04:43:02 PM

Document Has Been Signed on 06/28/2022 04:43 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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:THOMPSON FAMILY CHILD CAREFACILITY NUMBER:
197700349
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 4DATE:
06/28/2022
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
04:00 PM
MET WITH:Kendra ThompsonTIME COMPLETED:
05:15 PM
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Licensing Program Analyst (LPA) Lady King-Lewis conducted an unannounced prelicensing inspection for the purpose of an increase of capacity from an 8 Family Child Care Home(FCCH) to a 14 FCCH. LPA was greeted by licensee Kendra Thompson who guided the LPA on a tour of the Family Child Care Home. Upon arrival 4 children were in care. Licensee is aware an assistance must be present when more than 8 children are in care.

The day care take place in the following area of the home: playroom/patio, hallway bathroom, and rear-yard. The off limit areas for the day-care are all bedroom, living room, family room dining area, kitchen and garage. There is no pool/spa on the premises. Family members residing in the home include Licensee, and 3 minor children. Days/hours of operation will be Monday through Friday 7:00 AM to 5:00 PM



The home was inspected inside and out for safety, comfort, cleanliness, telephone service, heating (central) and ventilation, inaccessibility to poisons, detergents/cleaning compounds, medicines and hazardous items that can pose a danger to children. (sharp knives stored on top of refrigerator).

The fenced outside play area is free from defects or dangerous conditions.
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Lady King
LICENSING EVALUATOR SIGNATURE: DATE: 06/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/28/2022
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: THOMPSON FAMILY CHILD CARE
FACILITY NUMBER: 197700349
VISIT DATE: 06/28/2022
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Per Licensee there are no weapons or firearms on the premise. LPA did not observe any weapons in the home. There are age appropriate toys. Age appropriate napping equipment (cots). The required fire extinguisher (2A10BC) and smoke detector are in operable condition. The home has a Carbon Monoxide detector. Fireplace is screened (Family Room). Home has central AC and heat.

Licensee is aware of the following:


Capacity requirements, Notification of Parent's Rights, Roster requirements, Documentation requirements for disaster drills (fire and earthquake). Mandatory Forms for the children’s files and provider’s files, Safe Sleep Regulation. The role and responsibilities of being a mandated reporter were reviewed.

Licensee is aware that all employees or volunteer at the day-care shall be fingerprint clearances and associations to Licensee day care facility, provide a cleared TB test result, be immunized against pertussis, measles and maybe immunized against influenza. Licensee is aware personnel shall complete training on preventive health practices including CPR and first aid if licensee will be leaving personnel at the facility alone.

Licensee is aware of the requirement to report unusual incidents and/or injuries to the parent/guardian and Licensing within 24 hours of incident by telephone and in writing within 7 day of incident on the form LIC624B per the regulation.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Lady King
LICENSING EVALUATOR SIGNATURE:

DATE: 06/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2022
LIC809 (FAS) - (06/04)
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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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: THOMPSON FAMILY CHILD CARE
FACILITY NUMBER: 197700349
VISIT DATE: 06/28/2022
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Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.html

During this inspection facility was observed to be in compliance with Title 22. The application for a Large Family Child Care Home with a maximum capacity of 0012 or 0014 with parent notification will be submitted for approval.

An exit interview was conducted, and a copy of this report was provided to the licensee on this date.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Lady King
LICENSING EVALUATOR SIGNATURE:

DATE: 06/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2022
LIC809 (FAS) - (06/04)
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