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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198019270
Report Date: 07/20/2021
Date Signed: 07/20/2021 12:50:08 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:PALMER FAMILY CHILD CAREFACILITY NUMBER:
198019270
ADMINISTRATOR:KELSIE & VICTORIA PALMERFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 427-1437
CITY:PARAMOUNTSTATE: CAZIP CODE:
90723
CAPACITY:14CENSUS: 9DATE:
07/20/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Veronica & Kelsie PalmerTIME COMPLETED:
01:15 PM
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Licensing Program Analyst (LPA) Rita Ramos conducted an unannounced annual inspection to the above facility on 07/20/2021. LPA arrived at the facility at 10:45AM and met with Victoria and Kelsie Palmer, Licensees. Victoria Palmer guided LPA on a tour of the facility. Also present during this inspection, was Victor Palmer, Licensees' relative. Per Licensee, operation hours are Monday through Friday from 6AM to 6PM. There are 13 children that are currently enrolled. A children’s roster was available for review, however, LPA advised Licensees that all listed items need to be completely filled out. There were 8 children present upon arrival. One more child arrived during the inspection.

This is a two-story home which consists of 6 bedrooms, 4 bathrooms, kitchen, dining room, living room, den, front yard and backyard (fenced). The children use the bathroom downstairs next to the living room and dining room areas via the hallway. LPA observed that there is a fireplace between the den and dining room areas and it is screened. Per Licensee, areas off limits to children and parents include: 4 bedrooms upstairs and 3 bathrooms. Stairs were observed to be barricaded for children under the age of 5 that were present. The licensee provides food for children in care.

Individuals who reside in the home were noted and discussed. All adults present in the home have obtained a criminal record clearance or exemption prior to working, residing or volunteering in the licensed childcare home. Licensee states that there are no firearms stored in the home.

All areas identified on the facility sketch that are accessible for children to use were inspected. At 11:02AM LPA observed that children's blankets were all bundled together inside a play yard, the table next to where children eat was covered with several items that children in care can have access to. There is telephone service via a landline and a cellphone that is used. There is ventilation and heating. Safe toys play equipment and materials were observed. -----Page 1 of 4
SUPERVISOR'S NAME: Trevino CochranTELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Rita RamosTELEPHONE: (323) 981-3985
LICENSING EVALUATOR SIGNATURE:

DATE: 07/20/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2021
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 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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: PALMER FAMILY CHILD CARE
FACILITY NUMBER: 198019270
VISIT DATE: 07/20/2021
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LPA observed a bottle of Lysol spray and some Oxy Clean that although may not be directly within reach from younger children in care, other children in care can access it. LPA advised that the Licensee store them in a higher area. While inspecting the restroom, LPA again advised that some of the personal care items can be stored higher so the older children in care not have access to them. Licensees removed the items during the inspection. LPA also observed a mop and bucket near the entrance of the facility. Per Licensee, poisons are locked in a shed outside. Licensee understands that poisons must be locked with a key or combination lock.

The valve on the required 2A 10BC fire extinguisher indicates fully charged and was serviced on 07/01/21, as indicated on service tag. Smoke and carbon monoxide detectors were tested and are operable.

Licensees state that they are currently caring for infants. Licensee states that infants sleep in the napping room. LPA observed the napping room and advised Licensee that infants are to be constantly supervised. Appropriate sleeping arrangements and cribs were observed. There is one play yard for each infant in care. Play yards did not hinder the entrance or exit from the sleeping space. LPA advised that the mattresses shall be firm and covered with a fitted sheet that overlaps the underside so it cannot be dislodged. LPA advised Licensee that cribs and play yards are to be free of loose articles and objects. LPA observed loose blankets and bedding on the play yards but no infants sleeping in them. Licensee Victoria Palmer, removed the blankets and bedding during the inspection. LPA did not observe any infants swaddled while in care. LPA advised the Licensee that infants shall be placed on their backs for sleeping and shall be supervised. Infants shall be checked on every 15 minutes and the time of each 15-minute check shall be documented with child’s name and date. The LIC 9227 Individual Infant Sleeping Plan shall be completed for each infant up to 12 months of age. A copy of the LIC 9227 was provided to Licensee. Licensee had a sleeping log available, however, LPA discussed the documentation of labored breathing, signs of distress, flushed skin color, body temperature, and sleep position (on their backs).

Per Licensee, the children play in the backyard or at the local park for outdoor play. LPA inspected the backyard at 11:05AM and advised Licensees to clear and clean the concreted area from hazardous items. Currently, children are using the back yard for outdoor play time. The outdoor play area was observed to be fenced. LPA observed that the outdoor yard has toys and other materials for children to play with. The licensee states that supervision is always provided.---Page 2 of 4

SUPERVISOR'S NAME: Trevino CochranTELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Rita RamosTELEPHONE: (323) 981-3985
LICENSING EVALUATOR SIGNATURE:

DATE: 07/20/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2021
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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: PALMER FAMILY CHILD CARE
FACILITY NUMBER: 198019270
VISIT DATE: 07/20/2021
NARRATIVE
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The licensees were observed to be operating within the license capacity limitations. LPA did not observe any children left in parked vehicles. Car seats shall only be used for transportation. LPA did not observe any children sleeping in car seats.

The licensees and other personnel have completed training on preventive health practices including Pediatric First Aid and CPR. The licensee's Pediatric First Aid and CPR expires on 07/01/22. There are first aid supplies available. LPA advised that if a child shows signs of illness he/she/they shall be separated from other children.

Children’s records were reviewed and were observed to be incomplete. LPA provided Licensees with a list of the forms that are required to be on file and signed by parent/guardian or authorized representative. None of the children's files were observed to have the LIC 700 Identification and Emergency Information. Licensees had their own emergency forms, however, they do have all of the required information listed on the LIC 700.

The licensees do have proof of immunization against influenza, pertussis, and measles.

LPA observed that the Licensees do have proof of the Mandated Reporter AB 1207 compliant Child Care Training Certificate on file.

LPA issued a Confidential Names List (LIC 811) to the licensee which documents staff and children’s files reviewed during this inspection.



LPA did/did not observe any pools, spas, hot tubs, fish ponds, or similar bodies of water during the inspection.

LPA provided the licensee with a copy of A Child Care Provider’s Guide to Safe Sleep, by American Academy of Pediatrics. LPA also consulted and explained Child Abuse Reporting, Never Shake a Baby, and Safe Sleeping practices.



----Page 3 of 4
SUPERVISOR'S NAME: Trevino CochranTELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Rita RamosTELEPHONE: (323) 981-3985
LICENSING EVALUATOR SIGNATURE:

DATE: 07/20/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2021
LIC809 (FAS) - (06/04)
Page: 3 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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: PALMER FAMILY CHILD CARE
FACILITY NUMBER: 198019270
VISIT DATE: 07/20/2021
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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.

LPA advised the licensee to access forms, regulations and quarterly updates online at: www.ccld.ca.gov. LPA also discussed the Provider Information Notices (PINS) on Safe Sleep Awareness: PIN 19-02-CCP, COVID FAQ - PIN 20-11-CCP, Required Lead Testing: PIN 20-01 CCP Effects of Lead Exposure, and Guardian User Account Access - PIN 20-20-CCLD.

Capacity Handout (Small & Large) was provided during this inspection.

The following deficiencies listed on the attached LIC 809 (deficiency page) are being cited in accordance with California Code of Regulations Title 22. Deficiencies that are being cited need to be cleared to protect the children’s health & safety.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit made by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.

Exit interview was conducted with Victoria and Kelsie Palmer, Licensees, including, but not limited to Appeal Procedures/Appeal Rights, site visit and agency's consultative role.

-----Page 4 of 4
SUPERVISOR'S NAME: Trevino CochranTELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Rita RamosTELEPHONE: (323) 981-3985
LICENSING EVALUATOR SIGNATURE:

DATE: 07/20/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2021
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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: PALMER FAMILY CHILD CARE
FACILITY NUMBER: 198019270
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/20/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/03/2021
Section Cited

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Operation of a Family Child Care Home
(b)The home shall be kept clean and orderly, ---This requirement is not met as evidenced by LPA observing children's blankets bundled, tables not orderly, a mop bucket was observed and the outdoor yard was not ordely. This poses a potential health and safety risk to children in care.
Type B
08/03/2021
Section Cited

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Operation of a Family Child Care Home

(g)(8) Each family child care home shall have a current roster of children as specified in Health and Safety Code Section 1596.841.

This requirement is not met as evidenced by
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LPA observing that the facility roster is missing address, contact numbers, and dates. This poses a potential health and safety risk to children in care.
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Per Licensee, all files will be completed with the required forms and emergency information. Copies will be submitted by POC due date of 08/03/21.
Type B
08/03/2021
Section Cited

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Child's Records
(b)The licensee shall maintain, in each child's record, a copy of the emergency information card as required in Section 102417(g)(7).
This requirement is not met as evidenced by child records not having the emergency information on file. This poses a potential health and safety risk to children in care.
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: Trevino CochranTELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Rita RamosTELEPHONE: (323) 981-3985
LICENSING EVALUATOR SIGNATURE:
DATE: 07/20/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/20/2021
LIC809 (FAS) - (06/04)
Page: 5 of 5