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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 444410956
Report Date: 04/25/2023
Date Signed: 04/26/2023 01:29:40 PM

Document Has Been Signed on 04/26/2023 01:29 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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:PALMERIN, ESTELAFACILITY NUMBER:
444410956
ADMINISTRATOR:ESTELA PALMERINFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(831) 728-8094
CITY:WATSONVILLESTATE: CAZIP CODE:
95076
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 5DATE:
04/25/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Estela PalmerinTIME COMPLETED:
01:00 PM
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Licensing Program Analyst (LPA), Elizabeth Berumen conducted a Required - 1 Year Inspection. LPA met with Licensee, Estela Palmerin, and explained the nature of today's inspection with her. Also present in the home were 5 day care children (one infant and four preschoolers) and Licensee's adult son (Zino Zamudio). All required posted materials were posted. The day-care is open Monday thru Friday from 6:00 AM to 6:00 PM. There are no active waivers or exceptions for this facility. The day-care is a one storey home with three bedrooms and 1 bathroom. Per Licensee, the adults that reside in the home are herself, her husband (Armando Zamudio), and her son (Zino Zamudio). Licensee states that she has a minor daughter age 13 who also lives in the home.

LPA observed a current children's roster (LIC9040). Copy of children's roster was obtained during the inspection. The last Fire/disaster drill was conducted on March 20, 2023. LPA observed a fully charged 3A40BC fire extinguisher, functioning smoke and carbon monoxide detectors, and glass covered fireplace. Licensee states that there are no weapons or firearms in the home.

Incidental Medical Services (IMS) policy was discussed. Licensee states that she is not planning to administer any medication at this time. For IMS information see Evaluator Manual- Regulation Interpretations and Procedures for Family Child Care Homes, Section 102417. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice 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: http://www.ada.gov/childqanda.htm

LPA reminded licensee that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.
Continuation on next page:
SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Elizabeth Berumen
LICENSING EVALUATOR SIGNATURE: DATE: 04/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/25/2023
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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: PALMERIN, ESTELA
FACILITY NUMBER: 444410956
VISIT DATE: 04/25/2023
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Off limit areas in the home: three bedrooms. The backyard is fenced and safe for children. Cleaning products, sharp objects, and other items that are dangerous to children were stored inaccessible. LPA observed sufficient age-appropriate materials, toys, and play equipment in the facility. The children's bathroom is clean, sanitary, and operable. The home has a working telephone which is (831) 728-8094; Licensee provided LPA with her cell phone number (831) 406-2213. No bodies of water were observed.

LPA reviewed 5 children’s files during today's inspection for the following records: Notification of Parents Rights (LIC995A), Consent for Emergency Medical Treatment (LIC627), Identification and Emergency Information (LIC700), and Immunization Records (PM 286/CDPH 286).

LPA reviewed one helper's file for the following records: Employee Rights, required immunization's and TB test. Licensee's Mandated Reporter Training expires on February 15, 2025. LPA reminded Licensee that Mandated Reporter Training must be renewed by all staff every 2 years. Licensee has immunization in Measles, Pertussis, and Influenza. Licensee and her helpers have current Pediatric CPR/First Aid certifications.
Zino Zamudio Palmerin is missing the Statement Acknowledging Requirement to Report Child Abuse (LIC 9108) in his file. Licensee stated that she will download and print one and have him sign and file in his file.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process

Exit interview conducted and report was reviewed with Licensee, Estela Palmerin.

As a result of today's inspection, there were no deficiencies cited.

A NOTICE OF SITE VISIT WAS GIVEN AND MUST REMAIN POSTED FOR 30 DAYS.
SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Elizabeth Berumen
LICENSING EVALUATOR SIGNATURE:

DATE: 04/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/25/2023
LIC809 (FAS) - (06/04)
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