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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414002951
Report Date: 11/07/2019
Date Signed: 11/07/2019 02:22:34 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:PALMIERY, GERALDINEFACILITY NUMBER:
414002951
ADMINISTRATOR:PALMIERY, GERALDINEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 477-3507
CITY:SAN MATEOSTATE: CAZIP CODE:
94401
CAPACITY:14CENSUS: 7DATE:
11/07/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
01:05 PM
MET WITH:Geraldine PalmieryTIME COMPLETED:
02:40 PM
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Licensing Program Analyst (LPA) Marie Rodriguez made an unannounced Annual Random inspection. LPA met with Licensee Geraldine Palmiery and explained purpose of inspection. Present in home were the Licensee, her husband, and 7 children (1 infant and 6 preschool age). Licensee is operating within capacity requirements on this day. All adults living or working in the home have a criminal record clearance on file. Hours of operation are Monday to Friday from 8:00 am to 5:30 pm.

Day Care Areas: Living room, dining room, bedroom #2 (infant room), bathroom #1, and side yard. Off Limit Areas: Kitchen, laundry room, bedroom #1, bedroom #3, and bathroom #2. LPA inspected day care areas of home with Licensee. LPA observed home to be clean and in good repair with proper temperature and ventilation. There are no bodies of water on the property. Per the Licensee, there are no weapons or firearms in the home. There is a variety of age appropriate toys and equipment in the home and outside in the outdoor play area which are in good condition. Outdoor play area is fenced for supervision. Napping equipment is in good condition and properly stored. All cleaning supplies, poisons, and other chemicals are stored inaccessible to children. There is a working smoke detector and carbon monoxide detector, a fully charged fire extinguisher, and a working telephone.

Five children records reviewed were complete. All children have a record of emergency identification information on file. Licensee's record was reviewed and complete. Licensee's Pediatric First Aid/CPR certificate expires February 2020. Last emergency drill was conducted on October 15, 2019. Emergency drills are conducted every month and are properly logged. Incidental Medical Services (IMS) was discussed. Licensee has no children who need services at this time.

(Continued on second page)
SUPERVISOR'S NAME: Alma MaligTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Marie RodriguezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 11/07/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2019
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
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: PALMIERY, GERALDINE
FACILITY NUMBER: 414002951
VISIT DATE: 11/07/2019
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During inspection,
  • Licensee was given information regarding Safe Sleep Practices.
  • Licensee was reminded, as of September 1, 2016, all Staff and Volunteers must provide proof of immunization against pertussis, measles, and influenza, or qualifies for an exemption, pursuant to Health and Safety code 1596.7995 and 1597.662.
  • Licensee was provided information regarding Americans with Disabilities Act (ADA): 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: www.ada.gov/childqanda.htm.
  • Licensee was reminded about Mandated Reporter training available on CCLD website. Training must be completed every 2 years. Training can be taken online at www.mandatedreporterca.com
  • Licensee was reminded about the Provider Information Notices (PINs) on CCLD website.
  • Licensee was advised for any additional questions to contact CCLD office, Monday to Friday, 8:00 am - 5:00 pm, (650) 266-8800 or 1 (844) 538-8766. Website: www.cdss.ca.gov.

No deficiencies cited today.

This report was reviewed and discussed with Licensee Geraldine Palmiery. A copy of report was provided.
Notice of site visit was observed being posted and shall remain posted for 30 days.
SUPERVISOR'S NAME: Alma MaligTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Marie RodriguezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 11/07/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2019
LIC809 (FAS) - (06/04)
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