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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191611228
Report Date: 05/30/2019
Date Signed: 05/30/2019 05:23:24 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:PALAZZOLO FAMILY DAY CAREFACILITY NUMBER:
191611228
ADMINISTRATOR:NOEMI PALAZZOLOFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 836-1978
CITY:CULVER CITYSTATE: CAZIP CODE:
90232
CAPACITY:12CENSUS: 9DATE:
05/30/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
02:40 PM
MET WITH:Noemi Palazzolo, Licensee, Licensee's Husband and Licensee's assistantTIME COMPLETED:
04:25 PM
NARRATIVE
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On 5/30/19, Denise Miranda, Licensing Program Analyst (LPA) conducted an unannounced annual/required visit inspection to ensure the health & safety standards as required by regulations governing family child care homes are being met. Upon arrival, at 2:45pm, LPA met with co-licensee Noemi Palazzolo, Co-licensee, co-licensee’s husband and Co-licensee assistant. LPA informed co-licensee of nature of the visit and was guided on a tour (inside and outside) of the home. LPA confirmed with licensee that all adults residing/working in the home have criminal record. Upon arrival LPA Miranda observed nine children. Five of the children are under 2 year old and 4 four over two years old.
During this visit co-licensee stated the licensee is living in the another duplex home (different address). LPA provided new application form LIC279, declaration form to provide to Regional Office informing that licensee is not longer providing service and living at the Facility address. Co-licensee will provide this documents to Regional Office no later than 6/3/2019.
This is a 1 story detached duplex, 2 bedrooms bathroom, kitchen, living room combine with dine room no garage and a den. There is no pool, spa or other bodies of water on the premises. Family members residing in the home include licensee, co- and three adult’s family members. Licensee stated the facility is operating Monday-Friday 8:00am-6:00pm.
The accessible areas for child care include: Bedroom#1, bathroom, dining room, living room, kitchen with combining dining room.
The off-limits areas include: bedroom#1 and driveway located at the left side of the house.
At 2:45pm LPA observed full charged Fire extinguisher size 2A:10-B:C Fire Extinguisher full charged in the Den area. LPA observed working smoke and carbon monoxide detector, age appropriate toys. LPA observed at the living room living ceiling fan. LPA observed licensee and licensee’s assistant current First Aid Infant & Child CPR certifications are valid thru 04/2021. Telephone service, lighting and ventilation were evaluated and in good condition.
The licensee states that does not have weapons/firearms in the home and none observed by the LPA. LPA observed perimeter fencing for safety, age appropriate toys. The main entry door will not be used to enter the facility; Parents and children will use the side door to enter the facility.
SUPERVISOR'S NAME: Jennie FerreiraTELEPHONE: (424) 301-3067
LICENSING EVALUATOR NAME: Denise MirandaTELEPHONE: (424) 301-3055
LICENSING EVALUATOR SIGNATURE:

DATE: 05/30/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/30/2019
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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: PALAZZOLO FAMILY DAY CARE
FACILITY NUMBER: 191611228
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/30/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/30/2019
Section Cited
CCR
102416.5(d)(2)(d)
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Staffing Ratio and Capacity. For a Large Family Child Care Home, the maximum number of children for whom care may be provided at any one time when there is an assistant provider in the home, including children under age 10 who reside at the licensee's home and the assistant provider's children under age 10, shall be either:More than twelve and up to fourteen children
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During today's inspection, LPA observed a parent to pick up one infant child. The licensee will disenroll children immediately to bring the facility into compliance with infants and 2 school age children on the premises when there are 14 children present.
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only if the criteria in Section 1597.465 of the Health and Safety Code are met. No more than three infants are cared for during any time when more than 12 children are being cared for. This requirement is not met as evidenced by: On 05/30/19, LPA observed 5 infants and 4 preschoolers in care. This is an immediate health and safety risk.
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During this inspection, LPA provided licensee with a copy of Title 22 CCR 102416.5(d)(2)(b) Staffing Ratio and Capacity Regulation. Licensee will provide a written declaration stating her understanding of the above mentioned regulation no later than the close of business day today, 05/30/19.
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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: Jennie FerreiraTELEPHONE: (424) 301-3067
LICENSING EVALUATOR NAME: Denise MirandaTELEPHONE: (424) 301-3055
LICENSING EVALUATOR SIGNATURE:

DATE: 05/30/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/30/2019
LIC809 (FAS) - (06/04)
Page: 5 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: PALAZZOLO FAMILY DAY CARE
FACILITY NUMBER: 191611228
VISIT DATE: 05/30/2019
NARRATIVE
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Emergency Disaster Plan, Parent’s Rights Poster and the Facility License are required to be posted.
Licensee informed fire drill to be completed every 6 month and to keep a log and to ensure records for staff and children as well as a roster are kept for 3 years. Licensee informed no smoking in the premises during daycare hours of operation and was made aware that state law prohibits baby walkers, bouncy seats, exer-saucers and any other items that fall into that category.

Licensee was reminded that all infants must be placed on their backs when sleeping to prevent S.I.D.S. (Sudden Infant Death Syndrome), and that the Provider is required to wash hands after every diaper change and to never shake a baby to prevent the Shaken Baby Syndrome.

Licensee was also reminded that only children eating may be in high chairs and that car seats are utilized only for transportation.

LPA reminded co-licensee every two year to take the Mandated Reporter training: www.mandatedreporterca.com

Applicant was made aware of The Child Care Advocate Program (CCAP) that is administered from within the Community Care Licensing Division. CCAP participates in many community activities and special projects in order to disseminate information on the State’s licensing role, provide information to the public and parents on child care licensing, and provide many other helpful resources to the licensees and the public. CCAP’s direct contact information is as followed: Phone number: (916) 654-1541. Email Address: childcareadvocatesprogram@dss.ca.gov



During this inspection, LPA also provided the following documents about 1) A Safe Infant Environment Sleeping, 2) 1-844-LET-US-NO, 3) Never ever shake a Baby by California Department of Social Services, 4) California School Immunization Record form CDPH286, 5) California Law – Car Seat by California Department of Public Health, LIC311D Forms/Records to Keep in your Family Child Care Home, PUB458 Reporting Child Abuse and Neglet
The facility was found no to be in substantial compliance per Title 22 Regulations.
  • During this visit LPA observed 9 children which 5 were infants. LPA provided copy of lIC9224 form.
  • A copy of report, a Notice of Site Visit and advisory notes were issued and explained to the Licensee.
  • LPA will return to continue this inspection and review children's file.
SUPERVISOR'S NAME: Jennie FerreiraTELEPHONE: (424) 301-3067
LICENSING EVALUATOR NAME: Denise MirandaTELEPHONE: (424) 301-3055
LICENSING EVALUATOR SIGNATURE:

DATE: 05/30/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/30/2019
LIC809 (FAS) - (06/04)
Page: 4 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: PALAZZOLO FAMILY DAY CARE
FACILITY NUMBER: 191611228
VISIT DATE: 05/30/2019
NARRATIVE
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Licensee states at this time is not providing Incidental Medical Services (IMS): This facility plans to provide Incidental Medical Services – IMS. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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

Incidental Medical Services Include: Blood-Glucose Monitoring for Diabetic Children, Administering Inhaled Medication, Administering EpiPen Jr. and EpiPen or other Epinephrine Auto-Injectors, Glucagon Administration, Gastrostomy Tube Care (G-tube care), Insulin Injections Administration, Anti-Seizure Administration, and Emptying an Ileostomy Bag.



The following was discussed with the licensee:
Individuals who are 18 years of age or older living in the home must obtain a criminal record clearance. Individuals within one month of their 18th birthday must be fingerprinted immediately. Failure to obtain a criminal record background check clearances prior to initial presence in the home will result in an immediate $100.00 dollar or more per day Civil Penalty.
In the absence of the licensee a qualified adult must be present supervising the children; a qualified adult is an individual who has a valid and current adult/infant CPR & Pediatric First Aid certification and a valid criminal record clearance associated to the facility license and immunization. Licensee was informed, Absence of Supervision: including, but not limited to, a child left unattended, a child left alone with a person under 18 years of age, and lack of supervision resulting in a child wandering away. (HSC 1597.58(c)(2)). Regulation(s): 102417(k)(1) Children shall not be left in parked vehicles. Civil penalty applies when a child is left unattended in a parked vehicle.

Senate Bill 792: This bill, commencing September 1, 2016, prohibits a person from being employed or volunteering at a child care facility or family day care if he or she has not been immunized against influenza, pertussis and measles.

SUPERVISOR'S NAME: Jennie FerreiraTELEPHONE: (424) 301-3067
LICENSING EVALUATOR NAME: Denise MirandaTELEPHONE: (424) 301-3055
LICENSING EVALUATOR SIGNATURE:

DATE: 05/30/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/30/2019
LIC809 (FAS) - (06/04)
Page: 2 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: PALAZZOLO FAMILY DAY CARE
FACILITY NUMBER: 191611228
VISIT DATE: 05/30/2019
NARRATIVE
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New Immunization Requirement: Law enacted by SB 277, beginning January 1, 2016, personal beliefs exemptions will no longer be an option for the vaccines that are currently required for entry into child care or school in California. Personal beliefs exemptions already on file will remain valid until the child reaches the next immunization checkpoint.

New Appeal Process: A licensee may file an appeal, in writing 15 business days from the date of receiving the penalty assessment. All appeals must be sent to:
300 N. Continental Blvd., Suite 290-A
El Segundo, CA 90245
A current roster of children enrolled must be available and maintained for a period of three years, even after children no longer are attending the facility. Annual fees must be paid promptly and by the due date or a late fee shall be assessed, and/or the License shall be terminated. The fire extinguisher type 2-A:10-B:C must be serviced annually or as often as necessary and smoke and carbon monoxide detectors should check, and batteries replaced as needed. Changes should be reported to the Department as soon as they occur such as construction, remodeling, telephone number changes and/or if you move from your home. Any unusual incidents or injuries must be reported to the Department within 24 hours via telephone and within seven (7) days in writing. (use LIC624B for written report). Fire and safety drills must be performed every six months and documented for review by the Department.

Smoking is prohibited in a family child care home. Children and Staff records must be maintained and updated as needed and must be available for review by the Department. No smoking, No infant walkers, No Johnny jumpers, No saucer chairs, No trampolines and any other item that falls into that category are not permitted in the facility.

All adults living and working in the home shall be made of aware of the Departments right to inspection authority, which includes but not limited to the right to enter the home when children are being cared for, interview children and adults and review documentation.

SUPERVISOR'S NAME: Jennie FerreiraTELEPHONE: (424) 301-3067
LICENSING EVALUATOR NAME: Denise MirandaTELEPHONE: (424) 301-3055
LICENSING EVALUATOR SIGNATURE:

DATE: 05/30/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/30/2019
LIC809 (FAS) - (06/04)
Page: 3 of 5