243906530-6-26-2023-04-CC-YFIO-CT6N6A-20230626101049

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 243906530
Report Date: 06/26/2023
Date Signed: 06/26/2023 10:10:55 AM

Document Has Been Signed on 06/26/2023 10:10 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO-CC, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME:	PALMBERG, JAMEY FAMILY CHILD CARE		FACILITY NUMBER:	243906530
ADMINISTRATOR:	PALMBERG, JAMEY		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(209) 383-6613
CITY:	MERCED	STATE: CA	ZIP CODE:	95341
CAPACITY:	14	CENSUS: 0	DATE:	06/26/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:15 AM
MET WITH:	Jamey Palmberg		TIME COMPLETED:	10:30 AM

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On 06/26/2023 Licensing Program Analyst (LPA), Yesenia Fierro conducted an unannounced Annual Required Inspection and was met by Licensee, Jamey Palmberg. LPA explained the reason for the visit. LPA Fierro confirmed Days and Hours of operation are Monday thru Friday 07:30 AM-5:30PM. The home has a working telephone service and LPA Fierro confirmed the phone number is (209) 746-7019. All adults who reside or work in the home have a criminal record clearance or exemption. There are no excluded individuals present at this home.

LPA Fierro conducted a census, capacity as specified on the license is being maintained. A current facility sketch was reviewed, and Licensee confirmed that the kitchen, dining room, bathroom and playroom are used for providing care and are accessible to children. All other rooms are off-limits and made inaccessible by use of safety gates. LPA Fierro toured the home inside and outside.

LPA observed that stairs located in the dining room, stairs are barricaded when children are present. The electric fireplace located in the restroom is made inaccessible by a glass door, Licensee stated that fireplace will not be in use during daycare hours. There is a working fire extinguisher, smoke detector, carbon monoxide detector and adequate heating and ventilation for safety and comfort. LPA observed licensee test the smoke detector and carbon monoxide. Licensee understands to test both smoke detector and carbon monoxide periodically for functionality.

There are no firearms or ammunition on the premises. Licensee stated that all poisons are kept in shed/garage which is separate from the home. LPA did not observe any poisons during the inspection. Detergents, cleaning compounds, medication and other hazardous items are made inaccessible.

LPA observed 1 small dog in facility. Licensee understand the liability of pets around day care children and accepts responsibilities of any action taken by pets.

The outdoor play area in the backyard is fenced and there are no hazards to children present. LPA did observe a hot tub on the side of the house. Hot tub is secured with a tight fitting hard cover top and locks. CONTINUE 809-C

SUPERVISOR'S NAME: Rene Mancinas	TELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Yesenia Fierro	TELEPHONE: (559) 794-0709
LICENSING EVALUATOR SIGNATURE:	DATE: 06/21/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/21/2023

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
FRESNO-CC, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: PALMBERG, JAMEY FAMILY CHILD CARE	FACILITY NUMBER: 243906530
	VISIT DATE: 06/26/2023

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Licensee has a current roster of the children. An emergency fire/disaster drill has been completed and documented within the last 6 months. Licensee’s Mandated Reporter Training was completed on 06/2023. Licensee’s pediatric CPR/First Aid expires on 08/2024. A review of records indicates that all employees and/or volunteers have immunization records on file for influenza, pertussis, and measles.

Licensee ensures that children in care are supervised at all times and is aware children shall not be left in parked vehicles. Car seats are used for transportation purposes only and are not used for sleeping children.

LPA did not observe any infants in care during inspection. Licensee sated that they are not currently caring for any infants. LPA discussed Safe Sleep Regulations with licensee. LPA discussed the safe sleep regulations with licensee [or facility representative] and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep as an additional resource. LPA also informed licensee [or facility representative] 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.

Currently the facility is not providing Incidental Medical Services. Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02- CCP. 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: https://www.ada.gov/resources/child-care-centers/.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

During the exit interview, the LICENSEE Jamey Palmberg, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

CONTINUE 809-C

SUPERVISOR'S NAME: Rene Mancinas	TELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Yesenia Fierro	TELEPHONE: (559) 794-0709
LICENSING EVALUATOR SIGNATURE:	DATE: 06/26/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2023

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
FRESNO-CC, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: PALMBERG, JAMEY FAMILY CHILD CARE	FACILITY NUMBER: 243906530
	VISIT DATE: 06/26/2023

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Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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/inspection-process.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, no deficiencies are cited.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with the licensee Jamey Palmberg

SUPERVISOR'S NAME: Rene Mancinas	TELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Yesenia Fierro	TELEPHONE: (559) 794-0709
LICENSING EVALUATOR SIGNATURE:	DATE: 06/26/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2023

LIC809 (FAS) - (06/04)

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