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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197418290
Report Date: 10/21/2021
Date Signed: 10/21/2021 02:53:28 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:PALACIO FAMILY CHILD CAREFACILITY NUMBER:
197418290
ADMINISTRATOR:PALACIO DARLAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 696-9208
CITY:LOS ANGELESSTATE: CAZIP CODE:
90047
CAPACITY:14CENSUS: 5DATE:
10/21/2021
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Darla Palacio, LicenseeTIME COMPLETED:
03:15 PM
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On 10/21/2021 at 9:15am, Licensing Program Analyst Adrian Risher and LPM Maureen Neal conducted a case management inspection LPA & LPM were informed the licensee was at an appointment. LPA & LPM met with staff #1 Bria Davis. Five children were observed in the home. Names of the children were collected. LPA & LPM spoke to licensee via cell phone. Licensee stated she would return to the facility by 12 noon.

During the initial visit, LPA Risher and LPM Neal observed the home to be unclean and unkept. LPA Risher & LPM Neal observed several trash bags of clothes in the hallway leading to the bathroom. The bags blocked the pathway to the bathroom that the children in care use. In the kitchen, the safety gates were open and the made the kitchen accessible to the children in care. LPM observed an over flowing trash can with gnats flying around the trashcan. There were dishes piled up in the sink. There was a 24-hour Microban cleaning product observed on the floor in the kitchen next to the trashcan. LPA observed a bucket of dirty water with a mop in the dining area of the home adjacent to the kitchen

LPA Risher and LPM Neal returned to the home at 12:50pm for further observations and to meet with licensee. LPA observed the hallway leading to the bathroom clear. Licensee stated that it was her bags of laundry that were scheduled for pick up by her laundry service. LPA observed the Licensee had removed the filled trash bag from the kitchen.

SUPERVISOR'S NAME: Maureen NealTELEPHONE: (424) 301-3042
LICENSING EVALUATOR NAME: Adrian RisherTELEPHONE: (424) 301-3050
LICENSING EVALUATOR SIGNATURE:

DATE: 10/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 3
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: PALACIO FAMILY CHILD CARE
FACILITY NUMBER: 197418290
VISIT DATE: 10/21/2021
NARRATIVE
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Based on observations made during today’s visit, it has been determined that the facility is in violation of Operation of Family Child Care Home. LPA observed the home to be unclean and disorderly. A citation will be issued under section 102417 on attached 809d.

Exit interview was conducted. Appeal Rights and Notice of Site Visit will be provided.

SUPERVISOR'S NAME: Maureen NealTELEPHONE: (424) 301-3042
LICENSING EVALUATOR NAME: Adrian RisherTELEPHONE: (424) 301-3050
LICENSING EVALUATOR SIGNATURE:

DATE: 10/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2021
LIC809 (FAS) - (06/04)
Page: 2 of 3
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: PALACIO FAMILY CHILD CARE
FACILITY NUMBER: 197418290
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/21/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/21/2021
Section Cited

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102417
Operation of a Family Child Care Home
(b) The home shall be kept clean and orderly, with heating and ventilation for safety and comfort
This requirment was not as evidenced by:
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LPA observed the home to be unclean and disorderly during initial visit. LPA observed trash bags of clothes in the hallway blocking the path to the bathroom for the children in care. There were dishes piled up in sink and gnats flying in the kitchen. This poses a potential risk to the children in care.
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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: Maureen NealTELEPHONE: (424) 301-3042
LICENSING EVALUATOR NAME: Adrian RisherTELEPHONE: (424) 301-3050
LICENSING EVALUATOR SIGNATURE:
DATE: 10/21/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/21/2021
LIC809 (FAS) - (06/04)
Page: 3 of 3