<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 393612010
Report Date: 11/17/2021
Date Signed: 11/17/2021 02:01:41 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: 6DATE:
11/17/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Esmeralda PalmaTIME COMPLETED:
02:10 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 11/17/2021 at 12:45 PM Licensing Program Analyst (LPA) Jeevun Birk-Miller conducted a case management inspection and met with Licensee, Esmeralda Palma. During the inspection six day care children were present. The purpose of the inspection was to inspect the newly installed pool fencing and in ground pool located in the backyard. The LPA did not approve the pool fencing at this time. Licensee stated she will work on making the adjustments as soon as she can.

An exit interview was conducted and no deficiencies were cited at this time. A notice of site visit was given.
SUPERVISOR'S NAME: Jeanne SmithTELEPHONE: (916) 208-4405
LICENSING EVALUATOR NAME: Jeevun BirkTELEPHONE: (916) 917-6078
LICENSING EVALUATOR SIGNATURE:

DATE: 11/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/17/2021
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 1