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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304310216
Report Date: 06/29/2026
Date Signed: 06/29/2026 03:08:50 PM

Document Has Been Signed on 06/29/2026 03:08 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:PALMERI, MIRNAFACILITY NUMBER:
304310216
ADMINISTRATOR/
DIRECTOR:		PALMERI, MIRNAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(949) 463-4544
CITY:ALISO VIEJOSTATE: CAZIP CODE:
92656
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
06/29/2026
TYPE OF VISIT:OfficeUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:27 PM
MET WITH:Licensee, Mirna PalmeriTIME VISIT/
INSPECTION COMPLETED:
03:15 PM
NARRATIVE
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An Informal Meeting was conducted on 6/29/2026 in the Orange Regional Office. Present during the meeting were Licensing Program Manager (LPM), Tina Nguyen, Licensing Program Analyst (LPA), Kathy Trinh, and Licensee, Mirna Palmeri.

The purpose of this informal meeting is to discuss the following:

INFANT SAFE SLEEP 102425:

- (Type B) 06/02/2023 - 102425(j)(2)(D) Licensee did not have infant safe sleep logs.

- (Type B) 06/02/2023 - 102425(j)(1) Licensee did not document their observations on an infant safe sleep log every 15 minutes.

- (Type B) 01/10/2025 - 102425(b) Play yards were observed to have loose sheets and blankets.

- (Type B) 02/07/2025 - 102425(b) Play yard was observed to have loose sheets and blankets; repeat violation with civil penalty.

- (Type B) 06/11/2025 - 102425(j)(2)(D)(c) Licensee did not have infant safe sleep log available for review.

- (Type B) 04/22/2026 - 102425(j)(2)(D)(c) Licensee did not have documentation of the infant safe sleep log available for review; repeat violation with civil penalty.

- (Type B) 04/22/2026 - 102425(b) An infant was observed to be napping in a play yard while wearing a bib.

(Continue to page 2)

NAME OF LICENSING PROGRAM MANAGER: Tina Nguyen
NAME OF LICENSING PROGRAM ANALYST: Kathy Trinh
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 06/29/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/29/2026
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: PALMERI, MIRNA
FACILITY NUMBER: 304310216
VISIT DATE: 06/29/2026
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(Page 2)
- (Type B) 04/22/2026 - 102425(b)(1)(A) An infant was observed to be napping in a play yard with a pacifier that had an attachment.

- (Type A) 05/19/2026 - 102425(i) An infant was observed napping on a couch.

OPERATION OF A FAMILY CHILD CARE HOME 102417:

- (Type B) 06/02/2023 - 102417(g)(7) Licensee did not have complete children’s files.

- (Type B) 06/11/2025 - 102417(g) Safety gate was observed to be broken with sharp edges.

- (Type B) 04/22/2026 - 102417(g)(9)(A)1 Licensee did not have documentation of the emergency disaster drill log available for review.

CHILD’S RECORDS 102421:

- (Type B) 06/02/2023 - 102421(a) Licensee did not have and/or maintain children’s immunization records.

- (Type B) 06/02/2023 - 102421(b) Licensee did not have completed children’s files.

- (Type B) 04/22/2026 - 102421(a) Licensee did not have completed children’s files available for review.

CRIMINAL RECORD CLEARANCE 102370:

- (Type A) 02/07/2026 - 102370(d)(1) An assistant was working at the facility without a criminal record clearance.

ADDITIONAL HEALTH AND SAFETY TRAINING; CONDITION OF LICENSURE 1596.866:

- (Type B) 02/07/2025 - 1596.866(b) Assistant was observed supervising children alone without a current Pediatric CPR and First Aid certificate.

PERSONNEL RECORDS 102416.1:

- (Type B) 02/07/2025 - 102416.1(a) Licensee did not have a personnel record for an assistant working at the facility.

(Continue to page 3)

NAME OF LICENSING PROGRAM MANAGER: Tina Nguyen
NAME OF LICENSING PROGRAM ANALYST: Kathy Trinh
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/29/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2026
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
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: PALMERI, MIRNA
FACILITY NUMBER: 304310216
VISIT DATE: 06/29/2026
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(Page 3)
ADMINISTRATION OF CHILD DAY CARE LICENSING 1596.8662:

- (Type B) 06/11/2025 - 1596.8662(b)(1) Licensee did not have a current mandated reporter training certificate.

PERSONAL RIGHTS 102423:

- (Type B) 04/22/2026 - 102423(a)(2) Two infants were observed to be placed in a stroller when it was not used for transportation.

STAFFING RATIO AND CAPACITY 102416.5:

- (Type A) 05/19/2026 - 102416.5(b)(3)(a) Licensee was operating out of ratio.

During the informal conference, the licensee was given the opportunity to discuss violations and actions taken to address the deficiencies as follows:

Infant Safe Sleep, Operation of a Family Child Care Home, Child’s Records, Criminal Record Clearance. Additional Health and Safety Training; Condition of Licensure, Personnel Records, Administration of Child Day Care Licensing, Personal Rights, and Staffing Ratio and Capacity.

The following was discussed and provided with the Licensee:

· TSP referral has been made on 04/23/2026. Licensee indicated that she understands the regulations sections that were discussed during today’s meeting. LPM Nguyen also mentioned support provided based on the provider's language preferences.

· LPA provided the Licensee with the Capacity Handout, Title 22 Regulations, and Health and Safety Code aligning with the topics discussed today.

Exit interview was conducted with Licensee, Mirna Palmeri who agrees with the above. A copy of the report was read, explained, and provided to facility representatives. A signature on this form confirms receipt of the report.

End of report.

NAME OF LICENSING PROGRAM MANAGER: Tina Nguyen
NAME OF LICENSING PROGRAM ANALYST: Kathy Trinh
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/29/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2026
LIC809 (FAS) - (06/04)
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