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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198019270
Report Date: 11/08/2022
Date Signed: 11/08/2022 10:49:15 AM

Document Has Been Signed on 11/08/2022 10:49 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, 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: 9CENSUS: 3DATE:
11/08/2022
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Victoria Palmer, LicenseeTIME COMPLETED:
11:10 AM
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On November, 8 2022 at 9:45 AM, an unannounced Case Management-Legal inspection was conducted by Licensing Program Analyst (LPA) Susann Sanchez for the purpose checking to see if excluded individual is not present in the home. LPA met with Victoria Palmer, Licensee who gave LPA a tour of the home. Upon arrival LPA observed no day care children only the 3 children who live in the home. Per Licensee, facility had to close today 11/08/22 due to day care children being sick. Present at the facility was Licensee Kelsie Palmer and assistants Jessica Hogans and Jazmin Morgan who live in the home as well. Also present is Licensee partner.

Tour of the home was given at 10:10am including "off limit" areas. LPA observe excluded individual room, which still has belongings. Per Licensee Victoria Palmer, they work on clearing belongings on the weekends. LPA took pictures.

At 10:20am, Licensee Victoria Palmer left and LPA continued report with Licensee Kelsie Palmer.

LPA observe that 5 out of 9 parents have sign The Acknowledgement form (LIC 9224). Per Licensee the other 4 children come as needed so Licensee is still working on obtaining other signatures.

LPA obtained copies of Licensee's CPR & First Aid cards which expire on 10/2024. LPA cleared POC from 09/27/22.

Exit interview was conducted with Licensee Kelsie Palmer. 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: 11/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/08/2022
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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