Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 480111193
Report Date: 08/04/2016
Date Signed 08/29/2016 12:10:03 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
FACILITY NAME:THORSON FAMILY DAY CARE-VICKYFACILITY NUMBER:
480111193
ADMINISTRATOR:THORSON, VICKYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(707) 553-1357
CITY:VALLEJOSTATE: CAZIP CODE:
94591
CAPACITY:12CENSUS: 1DATE:
08/04/2016
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
04:35 PM
MET WITH:VickyTIME COMPLETED:
04:56 PM
NARRATIVE
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A visit was made to the facility by Araceli Canela LPA. There are presently 2 adults living in the home.

During today’s visit the home and grounds were toured and the licensee was operating within the licensed capacity. Operating hours are 7:00am to 5:30pm, Mon–Fri. The floor plan was verified. Off limits areas are inaccessible. There is a working telephone in the home. The fireplace insert is not used during day care hours. The licensee's pediatric CPR and First Aid are current, which expire 9/2017. Items which could pose a danger to children (detergents, cleaning compounds, and medications) were stored out of the reach of children. Poisons will be locked in top cabinet in laundry room. There is a working smoke detector, carbon monoxide detector and fire extinguisher in the home. The licensee has a current roster of children in care and has conducted an emergency drill within the past six months. The licensee stated there are no firearms and/or other dangerous weapons in the home and none were observed during today's visit. The children use the backyard as the outdoor play area and it is completely fenced. Children's records were reviewed and in compliance. All licensing reports are public information and must be made available upon request for at least three years. Not providing incidental medical services at this time.
Notice of Site Visit shall be posted for 30 days from today's visit.

The following violation(s) of the California Code of Regulations, Title 22; Division 12, were observed: see LIC 809D. The licensee was provided a copy of their appeal rights (LIC 9058 12/15)

SUPERVISOR'S NAME: Linda WalkerTELEPHONE: (707) 588-5026
LICENSING EVALUATOR NAME: Araceli CanelaTELEPHONE: (707) 588-1406
LICENSING EVALUATOR SIGNATURE:

DATE: 08/04/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2016
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, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
FACILITY NAME: THORSON FAMILY DAY CARE-VICKY
FACILITY NUMBER: 480111193
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/04/2016
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/05/2016
Section Cited
102417(g)(4)(A)
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Operation of a Family Child Care Home. Storage areas for poisons, firearms and other dangerous weapons shall be inaccessible to children and locked. Today there was a can of Raid in the laundry cabinet not Key locked. LPA made a B citation because it was inaccessible.
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send picture of correction by 8/5/16
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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: Linda WalkerTELEPHONE: (707) 588-5026
LICENSING EVALUATOR NAME: Araceli CanelaTELEPHONE: (707) 588-1406
LICENSING EVALUATOR SIGNATURE:

DATE: 08/04/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2016
LIC809 (FAS) - (06/04)
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