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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 393612010
Report Date: 07/23/2021
Date Signed: 07/23/2021 02:10:41 PM

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:PALMA, ESMERALDAFACILITY NUMBER:
393612010
ADMINISTRATOR:PALMA, ESMERALDAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 462-8891
CITY:STOCKTONSTATE: CAZIP CODE:
95206
CAPACITY:14CENSUS: 7DATE:
07/23/2021
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
01:25 PM
MET WITH:Esmeralda Palma TIME COMPLETED:
02:15 PM
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Licensing Program Analyst (LPA) Fabiola Diaz conducted an unannounced case management inspection (licensee initiated) and met with Licensee, Esmeralda Palma. On today's date, LPA observed 7 children in the home. The purpose of today's visit was to inspect the backyard and make sections of it off-limits. Licensee had informed LPA that an underground pool was being built in the backyard.

Today during the inspection, the backyard area outside of the orange fencing and playground became off-limits. The playground is completely surrounded by a fence. Licensee explained that in order for the children to walk to the playground, they have to go from the sliding door in the kitchen area to a small section under the back porch, and then through the gate into the playground. Licensee stated that children in care will be supervised at all times by an adult when walking to the playground and playing in the playground. Licensee stated children in care will not have access to the rest of the backyard that is outside of the temporary orange fencing and the playground. LPA inspected the walking area under the porch and the playground and found them to be free of hazardous items, and approved them to be on-limits. Licensee provided an updated backyard sketch with labels of what is on-limits and what is off-limits. Licensee stated that she understands that she must contact LPA prior to making any off-limits areas on-limits and vice versa. Licensee understands that if any new structural changes are made to the home; licensing must be notified prior to construction. LPA provided the Licensee with the Safe Sleep Regulation Concepts, Incidental Medical Services information, PIN 21-18-CCP with COVID-19 guidance, and Title 22 regulations describing bodies of water and pool fencing.

No citations were given during the inspection and an exit interview was conducted.
SUPERVISOR'S NAME: Jeanne SmithTELEPHONE: (916) 263-2002
LICENSING EVALUATOR NAME: Fabiola DiazTELEPHONE: (916) 206-9352
LICENSING EVALUATOR SIGNATURE:

DATE: 07/23/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/23/2021
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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