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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197700349
Report Date: 05/15/2023
Date Signed: 05/15/2023 01:18:13 PM

Document Has Been Signed on 05/15/2023 01:18 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
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:THOMPSON FAMILY CHILD CAREFACILITY NUMBER:
197700349
ADMINISTRATOR:THOMPSON, KENDRAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 471-9236
CITY:LANCASTERSTATE: CAZIP CODE:
93535
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 4DATE:
05/15/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:24 AM
MET WITH:Kendra ThompsonTIME COMPLETED:
01:20 PM
NARRATIVE
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On 05/15/2023, at 10:24 A.M., Licensing Program Analyst (LPA) Joselito L. Del Mundo conducted an unannounced annual inspection at Thompson Family Child Care Home to assess its ability to meet compliance with California Code of Regulations (CCR) Title 22, Health, and Safety requirements. LPA Del Mundo met with Licensee, Kendra Thompson and stated the reason for the inspection. The LPA provided copies of the LIC 126 Entrance Checklist Form, LIC 311D Forms/Records to Keep in the Family Child Care Home, and all records/forms that need to be maintain in the facility. Licensee guided the analyst on a tour of the day care areas. The day care take place in the following area of the home: daycare room and bathroom #1.

Licensee states the day care hours of operation is Monday to Friday from 7:00 A.M. to 5:00 P.M. Currently living in the home is licensee and three minor children (16, 11, and 6). Licensee is currently providing transportation to children in care. During this visit, LPA observed four children present in the facility.



Physical Plant: The home was inspected inside and out for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents/cleaning compounds, medicines and hazardous items that can pose a danger to children. All cleaning products and detergents are stored in the laundry room (off limits) which has a door and a safety knob and is inaccessible to children. Knives, cutleries, and other sharp items are stored on top of the refrigerator in the kitchen (off limits).

Licensee stated that household medications are stored in the lower cabinets of the kitchen (off limits). Per licensee, zero medications are currently being provided for the current children in care. Licensee stated that she is a member of the food program, and she is providing breakfast, morning snacks, lunch, and afternoon snacks.

The facility is a one-story house. The fireplace is adjacent to the kitchen (off limits) and is covered with a glass door. The home has central heating and air conditioning units.

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Joselito DelMundo
LICENSING EVALUATOR SIGNATURE: DATE: 05/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/15/2023
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 05/15/2023 01:18 PM - It Cannot Be Edited


Created By: Joselito DelMundo On 05/15/2023 at 11:45 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: THOMPSON FAMILY CHILD CARE
FACILITY NUMBER: 197700349

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/15/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee and assistant did not have a current mandated reporter training certificate which posed a potential Health, Safety or Personal Rights risk to persons in care.
POC Due Date: 06/09/2023
Plan of Correction
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Licensee will email copies of Mandated Reporter training certificate for licensee and assistant #1 to LPA.
Type B
Section Cited
HSC
1597.622(c)
Administration of Child Day Care Licensing
(c) The family day care home shall maintain documentation of the required immunizations or exemptions from immunization, as set forth in this section, in the person's personnel record that is maintained by the family day care home.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee assistant did not have immunization records on measles, pertussis and influenza which posed a potential Health, Safety or Personal Rights risk to persons in care.
POC Due Date: 06/09/2023
Plan of Correction
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Licensee will email copies of immunization records on measles, pertussis and influenza of assistant #1 to LPA.
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:Lady King
LICENSING EVALUATOR NAME:Joselito DelMundo
LICENSING EVALUATOR SIGNATURE:
DATE: 05/15/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/15/2023


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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 CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: THOMPSON FAMILY CHILD CARE
FACILITY NUMBER: 197700349
VISIT DATE: 05/15/2023
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Licensee stated that fire/earthquake drills were completed last April 4, 2023, and are conducted once a month. The facility has a fully charge fire extinguisher with a 2-A:10-B:C classification and the last service was on September 6, 2022. Safe and age-appropriate toys, kitchen set, supermarket set, doll house, playhouse, building blocks, cubbies with each child’s name labeled on it, tables and chairs were observed during the inspection. LPA also observed children’s books, crayons, painting, color markers, glue sticks, and small electronic drawing board. Licensee stated that she is taking the children to Tierra Bonita Park for the kids to play.



Licensee provides napping equipment like cots (6) with the individual child’s name labeled on it. Per licensee, she provides sheets and pillowcases, and parents bring their own child’s blankets. Licensee told LPA that she washes the sheets and pillowcases every Friday. During nap time, children nap in the daycare room. Per licensee, she has 1 dog and is using a dog kennel. Licensee also provided the shot records of the dog.

Licensee has two first aid kit boxes and are located in the cabinet of the kitchen and on top of the cubbies. The smoke detector and carbon monoxide detector were operable. LPA observed electrical outlets are covered with a plastic cover to prevent access to children in care.

Licensee is advised that baby bouncers, saucer chairs, or any recalled and or banned toys or sleep/ play equipment are prohibited on the premises. Licensee is advised to check for fixture, furniture and equipment that have been banned or recalled by the United States Consumer Product Safety Commission.

Bathroom: Toilet, sink and faucet were clean and operable. During the inspection, LPA did not observed razors and/or sharp objects, shampoos, mouthwash, medications, perfumes, air freshener, nail polish and nail remover that will pose a health and safety risk to children in care.



Currently, the licensee has 6 children enrolled in the facility. Licensee stated that when a child shows signs of illness, he/she is separated from other children on the other side of the dining room of the facility. Licensee added that parents of the child that has symptoms are called immediately.

Outdoor: The facility has no body of water on the premises. Per licensee, the outdoor play area is currently not being used. Per licensee, she supervised children while playing outside.
SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Joselito DelMundo
LICENSING EVALUATOR SIGNATURE:

DATE: 05/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2023
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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 CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: THOMPSON FAMILY CHILD CARE
FACILITY NUMBER: 197700349
VISIT DATE: 05/15/2023
NARRATIVE
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At the time of inspection, Licensee is aware of the requirement to report unusual incidents and/or injuries to the parent/guardian and Licensing on the day of the incident and/or 24 hours of incident by telephone, fax and/or in writing to the Department. Licensee is familiar with the Unusual Incident Report form, LIC624B. The report on unusual incident/injuries can also be mailed to [email protected]

Review of records to be maintained: LPA reviewed with licensee the LIC 311D, Forms/Records To Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted. LPA reviewed four children’s files and the Licensee and assistant’s files. Based on records review, the children’s files are complete; licensee and assistant #1 did not have a current mandated reporter training certificate. Licensee has proof of immunization against measles, pertussis, and influenza. Licensee has TB skin test on file. Assistant #1 did not have any immunization records against measles, pertussis, and influenza. Also assistant #1 did not have any TB skin test on file.

Licensee and other adults living in the home, working at and associated to the facility have received criminal record clearance.

The following was discussed with the licensee:

Licensee reminded that 100% supervision is required at all times to children in care. Licensee was made aware that it is he/her responsibility to know the regulations as well as anyone who assists in providing care. Licensing must have the facility’s phone number at all times; if the phone number is changed, licensing must be notified.



The regulation prohibits the smoking of tobacco in a private residence that is licensed as a family childcare home and in those areas of the family day care home where children are present (24/7 ban). State law prohibits baby walkers, bouncy seats, exersaucers, and any other items that fall into that category.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Joselito DelMundo
LICENSING EVALUATOR SIGNATURE:

DATE: 05/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2023
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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 CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: THOMPSON FAMILY CHILD CARE
FACILITY NUMBER: 197700349
VISIT DATE: 05/15/2023
NARRATIVE
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LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

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 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.htm

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to [email protected]. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process


The facility is not in compliance per Title 22 regulations. During today's inspection, LPA Del Mundo observed deficiencies that may hinder the health and safety of the children in care. Type B deficiencies were cited during this inspection. An exit Interview and discussion of observations were conducted with the licensee.

A copy of this Report was reviewed, Notice of Site Visit (LIC 9213) and Appeal Rights were provided to Licensee, Kendra Thompson.
SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Joselito DelMundo
LICENSING EVALUATOR SIGNATURE:

DATE: 05/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2023
LIC809 (FAS) - (06/04)
Page: 5 of 6
Document Has Been Signed on 05/15/2023 01:18 PM - It Cannot Be Edited


Created By: Joselito DelMundo On 05/15/2023 at 12:55 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
, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: THOMPSON FAMILY CHILD CARE
FACILITY NUMBER: 197700349

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/15/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1796.45

(a) Affiliated home care aides hired on or after January 1, 2016, shall submit to an examination 90 days prior to employment, or within seven days after employment, to determine that the individual is free of active tuberculosis disease.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee assistant #1 did not have a TB skin test which posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/09/2023
Plan of Correction
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Licensee will email a copy of assistant #1 TB skin test to LPA.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Lady King
LICENSING EVALUATOR NAME:Joselito DelMundo
LICENSING EVALUATOR SIGNATURE:
DATE: 05/15/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/15/2023


LIC809 (FAS) - (06/04)
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