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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198019270
Report Date: 12/06/2022
Date Signed: 12/06/2022 12:34:10 PM

Document Has Been Signed on 12/06/2022 12:34 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: 14CENSUS: 3DATE:
12/06/2022
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Kelsie Palmer, LicenseeTIME COMPLETED:
12:45 PM
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On 12/06/22, Licensing Program Analyst (LPA) Susann Sanchez, conducted an unannounced Case Management-Legal/Non-compliance Inspection. LPA met with Licensee Kelsie Palmer. The purpose for today's inspection is to ensure that the licenseee are operating in full compliance following the Decision & Ordered signed and dated 12/01/22. The Decision & Order shall become effective on 12/12/22.

LPA toured facility including off limit areas. Pictures were taken. During tour K. Palmer stated that they are still working on clearing Victor Palmer's old room and will be cleaned out by 12/11/22.

Licensee Victoria Palmer arrived at the facility around 11:50am.

Decision & Order - CDSS No. 7922255008B, the following was reviewed and observed:
  • LPA read all of the Decision & Order to both Licensees Kelsie & Victoria Palmer
  • Per Licensee Kelsie & Victoria Palmer stated that they both understand that respondent Victor Palmer is excluded from all care facilities licensed by the Department, certified by a licensed foster family agency, or any resource family home, and from holding the position of member of board of directors, executive director, or officer of licensee of any facility licensed by the department for the rest of respondent Victor Palmer life.
  • LPA provided a copy of Decision & Order to Licensees.
  • LPA reviewed all individuals residing or working in the home have been discussed.
  • All adults present during today's inspection in the home have obtained a criminal record clearance


The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit made by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00 No deficiencies cited. Exit interview was conducted with Licensee Victoria Palmer. Appeal Rights were given and explained.
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Susann Sanchez
LICENSING EVALUATOR SIGNATURE: DATE: 12/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/06/2022
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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