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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 525407848
Report Date: 12/13/2024
Date Signed: 12/13/2024 09:08:44 AM

Document Has Been Signed on 12/13/2024 09:08 AM - 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, 520 COHASSET RD., SUITE 170
CHICO, CA 95926
FACILITY NAME:PALOMINOS, MARIA FAMILY CHILD CARE HOMEFACILITY NUMBER:
525407848
ADMINISTRATOR/
DIRECTOR:		PALOMINOS, MARIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(530) 433-3937
CITY:CORNINGSTATE: CAZIP CODE:
96021
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 2DATE:
12/13/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:24 AM
MET WITH:Maria PalominosTIME VISIT/
INSPECTION COMPLETED:
09:18 AM
NARRATIVE
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On 12/13/24 Licensing Program Analyst (LPAs) Bianca Mendez conducted a plan of correction visit relating to deficiencies discovered on 12/3/24 during a annual inspection. licensee and

During the inspection, licensee's had a uncleared adult living in the home and did not have a criminal record clearance on file and did not have eligible clearance on Guardian. During the visit on 12/3/24 the licensee was issued a type A citation and a civil penalty of $500 dollars was issued for having a uncleared adult in the facility. Licensee is in the process of having adult obtain livescan clearance and understands that adult cannot return until they have a background clearance.

The following deficiencies were cited uncleared adult residing in the home (see LIC 809D):

SUPERVISORS NAME: Megan Aviles
LICENSING EVALUATOR NAME: Bianca Mendez
LICENSING EVALUATOR SIGNATURE: DATE: 12/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/13/2024
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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Document Has Been Signed on 12/13/2024 09:08 AM - It Cannot Be Edited


Created By: Bianca Mendez On 12/13/2024 at 08:33 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 520 COHASSET RD., SUITE 170
CHICO, CA 95926

FACILITY NAME: PALOMINOS, MARIA FAMILY CHILD CARE HOME
FACILITY NUMBER: 525407848

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/13/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/13/2024
Section Cited
HSC
1596.871(c)(1)(A)

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Subsequent to initial licensure, a person specified in subdivision (b) who is not exempt from fingerprinting shall obtain either a criminal record clearance or an exemption from disqualification, pursuant to subdivision(f) of this section or Section 1522.7, from the State Department of Social Services prior to employment, residence, or initial presence in the facility.

This requirement is not met as evidenced by:
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Licensee stated that she will have adult live outside the home until adult clears up their livescan and are cleared to be in the home effective 12/13/24.
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Based on observation and record review the licensee did not comply with the section cited above in which adult residing in the home does not have a current livescan which poses an immediate health, safety or personal rights risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Megan Aviles
LICENSING EVALUATOR NAME:Bianca Mendez
LICENSING EVALUATOR SIGNATURE:
DATE: 12/13/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/13/2024


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, 520 COHASSET RD., SUITE 170
CHICO, CA 95926
FACILITY NAME: PALOMINOS, MARIA FAMILY CHILD CARE HOME
FACILITY NUMBER: 525407848
VISIT DATE: 12/13/2024
NARRATIVE
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During today's site visit it was verified that licensee does have a uncleared adult in the home, during the visit the uncleared adult answered the door. A civil penalty of $900 was assessed during today's visit

LPA Bianca Mendez informed licensee Maria Palominos that this report dated 12/13/24 documents 1 Type A citation(s) which shall be posted for 30 consecutive days as there is an immediate risk to the health, safety, or personal rights of children in care.

Also, LPA Bianca Mendez informed the licensee to provide a copy of this licensing report dated 12/13/24 that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.


This report was reviewed and discussed with licensee, Maria Palominos. Notice of Site Visit shall be posted for 30 days from today's visit.
SUPERVISORS NAME: Megan Aviles
LICENSING EVALUATOR NAME: Bianca Mendez
LICENSING EVALUATOR SIGNATURE:

DATE: 12/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2024
LIC809 (FAS) - (06/04)
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