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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 480110902
Report Date: 04/04/2023
Date Signed: 04/04/2023 02:24:52 PM

Document Has Been Signed on 04/04/2023 02:24 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, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:THUMAS, NORMA FCCHFACILITY NUMBER:
480110902
ADMINISTRATOR:THUMAS, NORMAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(707) 344-6177
CITY:FAIRFIELDSTATE: CAZIP CODE:
94533
CAPACITY: 14TOTAL ENROLLED CHILDREN: 9CENSUS: 8DATE:
04/04/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
12:42 PM
MET WITH:Licensee Norma ThumasTIME COMPLETED:
02:35 PM
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Licensing Program Analyst (LPA) Elpidia Hernandez Torres arrived to the facility to conduct a Plan of Corrections (POC) visit. Licensee was cited one type A and two type B deficiencies previously on 03/07/2023, LPA arrived to verify licensee was operating with in ratio and to review children's records to verify infants in care have LIC 9227 on file and children's records are complete.

Children's record review began at 12:57PM, concluded at 02:00PM. Licensee and assistant were supervising eight children and were in ratio with capacity regulations. There were three infants in care, all three infants had sleep logs on file. C1 and C2 had Sleep plan on file. All children who are not yet attending public school have their immunizations on file on blue CDPH 286. All children have LIC 9224 on file signed and dated by guardian. Licensee and assistant both have valid AB 1207 mandated reporter training on file.

There were no title 22 deficiencies cited during todays visit.
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Elpidia Hernandez Torres
LICENSING EVALUATOR SIGNATURE: DATE: 04/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/04/2023
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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