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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 233007705
Report Date: 09/18/2023
Date Signed: 09/19/2023 09:23:40 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/21/2023 and conducted by Evaluator Leticia Rosales
PUBLIC
COMPLAINT CONTROL NUMBER: 01-CC-20230821150305
FACILITY NAME:REYNOSO/PALMERIN FAMILY CHILD CARE HOMEFACILITY NUMBER:
233007705
ADMINISTRATOR:REYNOSO, CLAUDIA & PALMERIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(707) 463-8468
CITY:UKIAHSTATE: CAZIP CODE:
95482
CAPACITY:14CENSUS: 1DATE:
09/18/2023
UNANNOUNCEDTIME BEGAN:
12:40 PM
MET WITH:Osvaldo PalmerinTIME COMPLETED:
02:05 PM
ALLEGATION(S):
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Licensees provided incomplete roster to the Department.

Licensees did not notify parents of type A citations.

Conduct inimical.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA), Leticia Rosales conducted an unannounced complaint inspection for the purpose of delivering complaint findings and met with Licensee, Osvaldo Palmerin. It was alleged that Licensees provided an incomplete roster to the Department on 8/11/23, and that Licensees did not notify parents of two type A citations by failing to provide the report issued on 8/11/23 as required. Conduct inimical was also alleged, specifically that the licensees had parents sign the Acknowledgement of Receipt of Licensing Reports LIC 9224 form without providing the 8/11/23 report.

LPA Rosales conducted interviews and record review which corroborate that licensees provided an incomplete roster of children in care to LPA Rosales on 8/11/23. The roster provided to LPA on 8/11/23 is missing Child 1 (C1), Child 6 (C6), Child 12 (C12), and Child 13 (C13). Interviews corroborate that licensees did not provide Parent 1 (P1), Parent 2 (P2), Parent 3 (P3), Parent 4 (P4), Parent 6 (P6), Parent 8 (P8) or Parent 10 (P10), with the 8/11/23 report which included two Type A citations. Interviews also corroborate that licensees had P2, P3, P4, P6, P8 and P10 sign the Acknowledgement of Receipt of Licensing Reports LIC 9224 form without providing the parents with the 8/11/23 report.

Continue on LIC9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Alexis Hollon
LICENSING EVALUATOR NAME: Leticia Rosales
LICENSING EVALUATOR SIGNATURE:

DATE: 09/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/21/2023 and conducted by Evaluator Leticia Rosales
PUBLIC
COMPLAINT CONTROL NUMBER: 01-CC-20230821150305

FACILITY NAME:REYNOSO/PALMERIN FAMILY CHILD CARE HOMEFACILITY NUMBER:
233007705
ADMINISTRATOR:REYNOSO, CLAUDIA & PALMERIFACILITY TYPE:
810
ADDRESS:563 DONNER LANETELEPHONE:
(707) 463-8468
CITY:UKIAHSTATE: CAZIP CODE:
95482
CAPACITY:14CENSUS: 1DATE:
09/18/2023
UNANNOUNCEDTIME BEGAN:
12:40 PM
MET WITH:Osvaldo PalmerinTIME COMPLETED:
02:05 PM
ALLEGATION(S):
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Licensees did not post type A citations in prominent location.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA), Leticia Rosales conducted an unannounced complaint inspection for the purpose of delivering complaint findings and met with Licensees Claudia Reynoso and Osvaldo Palmerin. It was alleged that Licensees did not post type A citations report in a prominent location after the licensees received the report on 8/11/23.

Based on interviews conducted, although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred, therefore the allegation is Unsubstantiated. There was no Title 22 deficiency cited based on the above finding. Appeal Rights were provided. Exit interview conducted and report was reviewed and discussed with licensee, Osvaldo Palmerin.

Notice of Site Visit shall be posted for 30 days from today's visit.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Alexis Hollon
LICENSING EVALUATOR NAME: Leticia Rosales
LICENSING EVALUATOR SIGNATURE:

DATE: 09/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 1
Control Number 01-CC-20230821150305
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: REYNOSO/PALMERIN FAMILY CHILD CARE HOME
FACILITY NUMBER: 233007705
VISIT DATE: 09/18/2023
NARRATIVE
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The preponderance of evidence standard has been met; therefore, the above allegations are found to be Substantiated. Title 22 deficiencies are being cited on the attached LIC 9099D and civil penalties are being issued. Appeal rights were provided. Exit interview conducted, and report was reviewed with Licensee, Osvaldo Palmerin.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

LPA Rosales informed Licensee, Osvaldo Palmerin that this report dated 9/18/23 documents three Type A citations 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. LPA Rosales informed Licensee, Osvaldo Palmerin to provide a copy of this licensing report dated 9/18/23 that documents three Type A citations 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. An Acknowledgement of Receipt of Licensing Reports LIC 9224 form must be completed and signed by each parent/guardian and placed in each child's file for verification
SUPERVISORS NAME: Alexis Hollon
LICENSING EVALUATOR NAME: Leticia Rosales
LICENSING EVALUATOR SIGNATURE:

DATE: 09/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 01-CC-20230821150305
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: REYNOSO/PALMERIN FAMILY CHILD CARE HOME
FACILITY NUMBER: 233007705
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/18/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/18/2023
Section Cited
HSC
1596.841
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Current roster of children provided care in facility required
Each child day care facility shall maintain a current roster of children who are provided care in the facility. The roster shall include the name, address, and daytime telephone number of the child's parent or guardian, and the name and telephone number of the child's physician.
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 Document is an Amendment
Licensee, Osvaldo Palmerin stated from now on I will enter child's information on the roster only once, and keep a current facility roster of children in care in one place.
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This roster shall be available to the licensing agency upon request. This requirement is not met as evidenced by: The roster licensees provided to LPA Rosales on 8/11/23 is missing Child 1 (C1), Child 6 (C6), Child 12 (C12), and Child 13 (C13).
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Type A
09/18/2023
Section Cited
HSC
1596.8595(c)(1)
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Posting licensing report by child care facility or home; duration of posting; civil penalty for failure to comply; reports to be provided to parents or guardian of each child receiving services.
(c)(1) A licensed child day care facility shall provide to the parents or guardians of each child receiving services in the facility copies of any licensing report that documents any Type A citation that represents an immediate risk to the health, safety, or personal rights of children in care as set forth in paragraph (1) of subdivision (a) of Section 1596.893b.
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Licensee stated I will provide parents/guardians with copies of any licensing report that documents any Type A citation as required.
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This requirement is not met as evidenced by: Licensees did not provide Parent 1 (P1), Parent 2 (P2), Parent 3 (P3), Parent 4 (P4), Parent 6 (P6), Parent 8 (P8) or Parent 10 (P10), with the 8/11/23 report which included two Type A citations.
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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.
SUPERVISORS NAME: Alexis Hollon
LICENSING EVALUATOR NAME: Leticia Rosales
LICENSING EVALUATOR SIGNATURE:

DATE: 09/18/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 01-CC-20230821150305
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: REYNOSO/PALMERIN FAMILY CHILD CARE HOME
FACILITY NUMBER: 233007705
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/18/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/18/2023
Section Cited
CCR
102402(a)(3)
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Revocation or Suspension of a License or Registration.
(a)The Department shall have the authority to suspend or revoke any license for the following reasons: (3) Conduct in the operation or maintenance of a family day care home which is inimical to the health, morals, welfare, or safety of either an individual in or receiving services from the facility or the people of the State of California.
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 Document is an Amendment
Licensee stated from now on I will notify and provide parents/guardian with copies of any licensing report Type A citation.
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This requirement is not met as evidenced by: Licensees had P2, P3, P4, P6, P8 and P10 sign the Acknowledgement of Receipt of Licensing Reports LIC 9224 form without providing the parents with the 8/11/23 report.
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I will provide the copies at the time of signing the Acknowledgement of Receipt of Licensing Reports LIC 9224 form.
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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.
SUPERVISORS NAME: Alexis Hollon
LICENSING EVALUATOR NAME: Leticia Rosales
LICENSING EVALUATOR SIGNATURE:

DATE: 09/18/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2023
LIC9099 (FAS) - (06/04)
Page: 5 of 5