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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343623795
Report Date: 08/20/2021
Date Signed: 08/20/2021 10:16:40 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME:PALOMBO, SANDRAFACILITY NUMBER:
343623795
ADMINISTRATOR:PALOMBO, SANDRAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 385-7219
CITY:SACRAMENTOSTATE: CAZIP CODE:
95826
CAPACITY:14CENSUS: 9DATE:
08/20/2021
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
08:50 AM
MET WITH:Sandra PalomboTIME COMPLETED:
10:30 AM
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Licensing Program Analyst (LPA) Gagandeep Singh met with licensee, Sandra Palombo, for a case management inspection. Licensee has made changes in the garage and requested the Department to inspect. Today’s inspection was to inspect the garage, which has been turned into a room, for any health and safety hazards. Present, there are nine children in care with licensee and two helpers.

During today’s inspection, LPA observed licensee has license and all other required documents posted and visible for the public. LPA observed licensee has converted the garage into a room. The garage door has been replaced with a wall and licensee has received the permit for the construction from the City. In the new room, LPA observed licensee has cushion matts in place in whole room. All unused electrical outlets have child protective covers installed. There is variety of age appropriate furniture and toys. All furniture is steady and in good repair. The house has multiple fire extinguishers and smoke alarms. The house has carbon monoxide detector. Cabinets in the kitchen have child protective locks installed. During inspection, LPA discussed the safe sleep regulations and provided the copy of PIN 20-24-CCP and copy of Infant sleeping plan form. LPA also discussed the COVID-19 precautions and face requirements with the licensee.

Updated garage has been approved as of today for child care. Child care areas will be Garage, Kitchen, Play area/ Living room, Play area # 2, Master Bedroom, Bathroom next to kitchen and Backyard. Off limit areas: Office, Bathroom next to master bedroom and storage shed in the backyard. No deficiencies are cited today. Copy of this report is reviewed and provided to the licensee. Notice of site visit is posted and shall remain posted for next 30 days.

SUPERVISOR'S NAME: Maria MayorgaTELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Gagandeep SinghTELEPHONE: (916) 216-7823
LICENSING EVALUATOR SIGNATURE:

DATE: 08/20/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2021
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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