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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198019270
Report Date: 07/28/2023
Date Signed: 07/28/2023 03:24:59 PM

Document Has Been Signed on 07/28/2023 03:24 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: 12DATE:
07/28/2023
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME BEGAN:
11:35 AM
MET WITH:Victoria Palmer, LicenseeTIME COMPLETED:
12:55 PM
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On 07/28/23, Licensing Program Analyst (LPA) Susann Sanchez, conducted an unannounced Case Management-Legal/Non-compliance Inspection. LPA met with Licensee Victoria Palmer. Also present at the facility was Licensee assistant Jasmine Morgan. The purpose for today's inspection is to ensure that the licensee are operating in full compliance following the Decision & Ordered- CDSS No. 7922255008B that became effective on date 12/12/22 and to provide Licensee with a copy of LIC 995B Family Child Care Home Addendum to Notification of Parents' Rights (regarding removal/exclusion).

There was 12 children, 1 assistant, 2 adults (that lives in the home & other Licensee Kelsie Palmer who was off today 07/28/23), present with Licensees when LPA arrived. LPA toured facility including off limit areas. LPA also conducted an annual inspection on today's date.
Decision & Order - CDSS No. 7922255008B, the following was reviewed and observed:
  • Licensee Victoria Palmer stated that she 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 Licensee, a copy was also provided on 12/06/22.
  • 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.
LPA provided a copy of the LIC 995B- "Family Child Care Home Addendum to Notification of Parents' Rights (regarding removal/exclusion). The Licensee was advised that a copy of the Family Child Care Home Addendum to Notification of Parents’ Rights (Regarding Removal/Exclusion) LIC 995B must be provided to the parents of current and newly enrolled children and a copy of signed LIC995B is required to be maintained in each the children’s file. Failure to have a signed LIC995B receipt for each child will result in a civil penalty of $100.00 per family.
The Notice of Site Visit (LIC 9213) – must remain posted for 30 days. Exit interview was conducted with Licensee V. Palmer.
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Susann Sanchez
LICENSING EVALUATOR SIGNATURE: DATE: 07/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/28/2023
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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