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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198019270
Report Date: 09/27/2022
Date Signed: 09/27/2022 01:19:38 PM


Document Has Been Signed on 09/27/2022 01:19 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, 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: 2DATE:
09/27/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:50 AM
MET WITH:Kelsie Palmer, LicenseeTIME COMPLETED:
01:40 PM
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Licensing Program Analyst (LPA) Susann Sanchez conducted an unannounced annual inspection to the above facility on 09/27/2022. LPA arrived at the facility at 9:50AM and met with Kelsie Palmer, Licensees. and guided LPA on a tour of the facility. Per Licensee, operation hours are Monday through Friday from 6AM to 6PM. There are 13 children that are currently enrolled. There were 1 daycare present upon arrival with parent and Licensee's infant child.

Licensee Victoria Palmer arrived around 11:00am with infant child.

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, den, one bedroom (downstairs), and the backyard. 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: 3 bedrooms upstairs and 2 bathrooms. Stairs were observed not to be barricaded. Technical violation was given. The licensee provides food for children in care.

Individuals residing in the home have been discussed and noted. All adults present in the home have obtained a criminal record clearance or exemption. 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 10:05AM.
LPA reviewed required posted documentation for Facility License, Publication (PUB) 394- Notification of Parent Rights and Licensing Form (LIC) 9148- Earthquake Preparedness form. Facility records were reviewed for LIC 9040- Facility Roster, LIC 610- Facility Disaster Plan and Disaster drill log, last drill conducted on 9/20/22.

Consult was given from 11:00 till 1:10 (off and on) regarding fingerprints, centers, and types of citations.
SUPERVISOR'S NAME: Valarie CookTELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Susann SanchezTELEPHONE: (323) 981-3366
LICENSING EVALUATOR SIGNATURE:
DATE: 09/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/27/2022
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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Document Has Been Signed on 09/27/2022 01:19 PM - It Cannot Be Edited

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: 09/27/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(4)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (4) Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above. LPA observed and photograph cleaning products and personal hygiene products under the kitchen and bathroom sink and was accessible to children, which poses a potential health, safety risk to persons in care.
POC Due Date: 10/11/2022
Plan of Correction
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LPA observed during inspection, Licensee remove some items. Per Licensee, was remove all items and placed them in the garage or buy latches and send LPA proof via email by POC due date of 10/11/22.
Type B
Section Cited
CCR
102416(c)
Personnel Requirements
(c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and interview, the licensee did not comply with the section cited above. Per Licensee was not aware that CPR & 1st Aid training needed to be completed every two years, which poses posed a potential health, safety risk to persons in care.
POC Due Date: 10/28/2022
Plan of Correction
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Per Licensee will take an in person CPR & 1st Aid class and send copies of the certificate via email by POC due date of 10/28/22.

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: Valarie CookTELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Susann SanchezTELEPHONE: (323) 981-3366
LICENSING EVALUATOR SIGNATURE:
DATE: 09/27/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/27/2022
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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: PALMER FAMILY CHILD CARE
FACILITY NUMBER: 198019270
VISIT DATE: 09/27/2022
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Smoke and carbon monoxide detector were tested and are operable. LPA observed required 2A10BC fire extinguisher, last serviced 8/01/2022. The home maintains telephone service via cell phone. The home is observed to be clean and orderly. There age appropriate equipment, toys and material available for children. Isolation area for sick children waiting to be picked up is in the dining area, away from the other children.

At 10:10am LPA observed that cleaning compounds, and hygiene products are stored in kitchen and in the bathroom and was not locked storage, accessible to children. Type B was cited.

Infant Care: Currently licensee has 2 infants enrolled. Appropriate sleeping arrangements and playpens 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 discussed new Safe sleep regulations, including LIC 9227 Infant Sleep Plan for infants under 12 months, 15-minute sleep check documentation for infants 0-24 months, and provided PIN 20-24-CCP.

Children use the part of the backyard that is connected to the den/dining area for outdoor play. There are no pools or spas, or other bodies of water. Facility does not have any pets in the facility.



Children’s records were reviewed for (LIC) 282- Affidavit Regarding Liability Insurance, Immunization Records, LIC 700- Identification and Emergency Information, LIC 627- Consent for Medical Treatment and, LIC 995A Notification of Parents’ Rights.

Staff records were reviewed for approved: LIC 508- Criminal Record Statement, Proof of immunization against measles, pertussis and influenza or influenza declination, TB clearance or risk assessment, LIC 9108- Statement Acknowledging Requirement to Report Child Abuse.

During file review, LPA did not observed Pediatric First Aid and CPR certification, per Licensee during interview, she was not aware certification needed to be renewed every two years. Type B was cited. Also during staff file review, LPA did not observe current Mandated Reporter Training, however, Licensee showed proof to LPA that she is currently in the process of completing course. Technical Violation was given.
SUPERVISOR'S NAME: Valarie CookTELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Susann SanchezTELEPHONE: (323) 981-3366
LICENSING EVALUATOR SIGNATURE:

DATE: 09/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2022
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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: PALMER FAMILY CHILD CARE
FACILITY NUMBER: 198019270
VISIT DATE: 09/27/2022
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During inspection all children were observed to be treated with dignity and respect, they were observed to be receiving safe, healthful and comfortable accommodations, furnishings and equipment, and free from corporal and/or unusual punishment.

LPA observed that licensee is implementing COVID-19 precautions and procedures.

Incidental Medical Services (IMS):
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 Center and the ADA, available at: http://www.ada.gov/childqanda.htm

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep web page at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

SUPERVISOR'S NAME: Valarie CookTELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Susann SanchezTELEPHONE: (323) 981-3366
LICENSING EVALUATOR SIGNATURE:

DATE: 09/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2022
LIC809 (FAS) - (06/04)
Page: 6 of 7
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: 09/27/2022
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Based on the LPA’s observations and records review, the following deficiencies listed on the attached LIC 809 (deficiency page) are being cited in accordance with California Code of Regulations Title 22.

A notice of site visit was given and must remain posted for 30 days. Appeal Rights were given and explained. Exit interview conducted and report was reviewed with the Licensee, Victoria Palmer
SUPERVISOR'S NAME: Valarie CookTELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Susann SanchezTELEPHONE: (323) 981-3366
LICENSING EVALUATOR SIGNATURE:

DATE: 09/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2022
LIC809 (FAS) - (06/04)
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