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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198019270
Report Date: 10/03/2022
Date Signed: 10/03/2022 01:45:16 PM

Document Has Been Signed on 10/03/2022 01:45 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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:PALMER FAMILY CHILD CAREFACILITY NUMBER:
198019270
ADMINISTRATOR:KELSIE & VICTORIA PALMERFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 427-1437
CITY:PARAMOUNTSTATE: CAZIP CODE:
90723
CAPACITY: 14TOTAL ENROLLED CHILDREN: 13CENSUS: 4DATE:
10/03/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Victoria Palmer, LicenseeTIME COMPLETED:
02:05 PM
NARRATIVE
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Licensing Program Analysts (LPA) Susann Sanchez conducted an unannounced case management- other inspection. LPA arrived at the facility at 9:40 am and met with licensee, Victoria Palmer whom was present with 2 children, 2 infants, and 2 assistants. LPA informed Licensee purpose of visit was to gather information of an incident that occurred at the facility on 04/16/22. Licensees failed to report incident to the department.

LPA toured the facility including "off limit" areas. Documentation was collected and photos were also taken.
Interviews were conducted with Licensee Victoria Palmer, assistant Jazmin Morgan, assistant/ resident Jessica Hogans, and a child regarding the incident that occurred on 04/16/22.

On 09/27/2022, LPA Sanchez conducted a annual inspection. LPA observed Victor C Palmer leaving the facility. Per Licensee Kelsie Palmer, Victor Palmer does not live in the home and he was only present at the facility to fix a leak on the second floor. Also present was Jessica Hogans, with her child. Both Victor C Palmer and Jessica Hogans were not fingerprint cleared on 09/27/22. Two civil penalties will be cited.

Licensee was informed that LPA will return to gather more information.

Based on the LPA observations and records review, the following deficiencies listed on the attached LIC 809D (deficiency page) are being cited in accordance with California Code of Regulations Title 22. Deficiencies that are being cited need to be cleared to protect the children’s health & safety.

A copy of this report shall be provided to the parent/guardian of children currently enrolled by the next business day or immediately upon return. A copy of this report shall also be provided to the parent/guardian of any newly enrolled children for the next 12 months (1 year). The Acknowledgement form must be maintained in each child’s file immediately upon receipt from parent. Licensee was provided with a copy of the parent Acknowledgement of Receipt of Licensing Reports Form during this visit.
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Susann Sanchez
LICENSING EVALUATOR SIGNATURE: DATE: 10/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/03/2022
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 10/03/2022 01:45 PM - It Cannot Be Edited


Created By: Susann Sanchez On 10/03/2022 at 12:26 PM
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
, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: PALMER FAMILY CHILD CARE
FACILITY NUMBER: 198019270

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/03/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/04/2022
Section Cited
CCR
102370(d)

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(d) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility: This requirement is not met as evidenced by interview with both licensees and observation. On 09/27/22, LPA observed Victor Constanti
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Jessica Hogans left the facility during annual inspection to get fingerprinted. Victor C Palmer left during inspection. Both Kelsie Palmer and Victoria Palmer stated that Victor Constanti Palmer Jr. was only at the facility at the time to fix a leak. Per Licensees, Victor Palmer is never at the facililty if children
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Palmer Jr. and Jessica Hogans present at the facility. This poses an immediate health, safety or personal rights risk to persons in care.
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are present. Licensee Victoria Palmer submitted a declaration stating that Victor Palmer will not be allowed at the facility during hours of operation.

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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:Valarie Cook
LICENSING EVALUATOR NAME:Susann Sanchez
LICENSING EVALUATOR SIGNATURE:
DATE: 10/03/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/03/2022


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 10/03/2022 01:45 PM - It Cannot Be Edited


Created By: Susann Sanchez On 10/03/2022 at 12:57 PM
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
, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: PALMER FAMILY CHILD CARE
FACILITY NUMBER: 198019270

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/03/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/11/2022
Section Cited
CCR
102416.2(a)

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102416.2(a) Reporting Requirements (a)The licensee shall report the following information the Department by telephone or fax within the Department's next business day and during normal working hours (8am to 5pm). The requirement was not met as evidenced by: based on interviews conducted with Licensee
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Per Licensee understands that reporting requirements are important and stated to the LPA that she understands that all incidents that affect her facility must be reported to the department within 24 hours. Licensee will review and train regulations with co-licensee Kelsie Palmer and with staff. Notes from
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Victoria Palmer. Licensee admitted that she did not report incident since incident was on a weekend 04/16/22. This poses a potential risk to the health and safety of children in care.
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training will be submitted to LPA by POC due date of 10/11/22.

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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:Valarie Cook
LICENSING EVALUATOR NAME:Susann Sanchez
LICENSING EVALUATOR SIGNATURE:
DATE: 10/03/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/03/2022


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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: PALMER FAMILY CHILD CARE
FACILITY NUMBER: 198019270
VISIT DATE: 10/03/2022
NARRATIVE
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Exit interview was conducted with Licensee Victoria Palmer. A copy of the appeal rights were provided and explained. The Notice of Site Visit shall be posted for thirty (30) consecutive days. Failure to maintain posting as required will result in a $100.00 civil penalty.
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Susann Sanchez
LICENSING EVALUATOR SIGNATURE:

DATE: 10/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2022
LIC809 (FAS) - (06/04)
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