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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 233007705
Report Date: 01/21/2026
Date Signed: 01/21/2026 02:44:25 PM

Document Has Been Signed on 01/21/2026 02:44 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
SANTA ROSA CC RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:REYNOSO/PALMERIN FAMILY CHILD CARE HOMEFACILITY NUMBER:
233007705
ADMINISTRATOR/
DIRECTOR:		REYNOSO, CLAUDIA & PALMERIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(707) 972-1609
CITY:UKIAHSTATE: CAZIP CODE:
95482
CAPACITY: 14TOTAL ENROLLED CHILDREN: 17CENSUS: 7DATE:
01/21/2026
TYPE OF VISIT:Annual/RequiredUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:40 AM
MET WITH:Claudia Reynoso and Osvaldo PalmerinTIME VISIT/
INSPECTION COMPLETED:
02:53 PM
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A Required Annual inspection was made to the facility by Licensing Program Analysts (LPAs), Robert Maciel and Jessica Gaumann. A review of staff records indicates that all facility staff or other individuals who require caregiver background checks received a criminal record and child abuse index clearances or exemptions. Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

During today’s inspection the home and grounds were toured. The Licensees were supervising 7 children and were operating within the licensed capacity and ratio requirements. No children were observed left in any parked vehicles. The facility’s operating hours are 5:45 AM to 5:30 PM, Mon–Fri. The floor plan submitted by the licensee was reviewed and verified. The children will have access to the daycare room, the kitchen, the living room, the downstairs bathroom, and the back yard. The off-limits areas of the home are the entire second floor, the downstairs bedroom, the office, and the front yard and were made inaccessible by baby gates. The home was at a comfortable indoor temperature. The children in care have access to age-appropriate toys and equipment. There is a working telephone in the home. Licensee’s pediatric CPR/First Aid certification was current and expires in April 2026. LPA observed accessible cleaning chemicals in the cabinet by the stairs in the living room and in the closet by the front door in the living room which were accessible to children in care. There is a functional smoke and carbon monoxide detector and a fully charged fire extinguisher rated at least 2A10BC. The Licensee stated that poisons are stored on the premises, none were observed by LPAs to be unlocked in locations accessible to children.


Continue to LIC 809-C.
NAME OF LICENSING PROGRAM MANAGER: Melchisedeck Augustin
NAME OF LICENSING PROGRAM ANALYST: Robert Maciel
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 01/21/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/21/2026
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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
SANTA ROSA CC RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: REYNOSO/PALMERIN FAMILY CHILD CARE HOME
FACILITY NUMBER: 233007705
VISIT DATE: 01/21/2026
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The regulation that poisons are to be locked using a key or combination lock was reviewed. Licensee stated that firearms are stored in the home, locked in a safe, separately from ammunition. LPA observed unlocked ammunition in a closet in a bedroom on the second floor which was not accessible to children due to a child gate at the base of the stairs.

There is no spa, pool, pond, or fountain observed on the premises and none shall be added without prior approval of the Licensing agency. Licensee recorded a disaster drill on 11/3/25. The facility roster of the children in care was reviewed. LPA review of children's records (C1-C5) revealed that the facility did not possess complete immunization records for C2-C5, did not possess the CDPH286 immunization record form for C1, did not possess record of the LIC282 Affidavit Regarding Liability Insurance for C2-C3, and did not record 15-minute sleep checks for a child (C4). Licensee stated that they believed that sleep checks were only required for children under the age of 1.

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: https://www.ada.gov/resources/child-care-centers/.



Continue to LIC 809-C.
NAME OF LICENSING PROGRAM MANAGER: Melchisedeck Augustin
NAME OF LICENSING PROGRAM ANALYST: Robert Maciel
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 01/21/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/21/2026
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
SANTA ROSA CC RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: REYNOSO/PALMERIN FAMILY CHILD CARE HOME
FACILITY NUMBER: 233007705
VISIT DATE: 01/21/2026
NARRATIVE
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On this date, 01/20/2026, the California Attorney General - Megan’s Law website was searched for information on sex offenders required to register with local law enforcement under California's Megan's Law. No registered sex offenders were found at the facility address. Under state law, some registered sex offenders are not subject to public disclosure; therefore, they may not have been included in this search. However, the Department conducts a monthly cross reference of each address on record for all registered sex offenders against all CCLD facility addresses pursuant to information shared by California DOJ. During the exit interview, the Licensee, Claudia Reynoso, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.



(Continued on LIC 809-C)
NAME OF LICENSING PROGRAM MANAGER: Melchisedeck Augustin
NAME OF LICENSING PROGRAM ANALYST: Robert Maciel
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 01/21/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/21/2026
LIC809 (FAS) - (06/04)
Page: 4 of 13
Document Has Been Signed on 01/21/2026 02:44 PM - It Cannot Be Edited


Created By: Robert Maciel On 01/21/2026 at 01:26 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
, 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: 01/21/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(4)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (4) Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, there was accessible cleaning chemicals in the cabinet by the stairs in the living room, in the closet by the front door in the living room which were accessible to children in care. Additionally, there was unlocked ammunition in the closet in a bedroom on the second floor which was not accesible due to a child gate at the base of the stairs which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/18/2026
Plan of Correction
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Licensee stated they would move the chemicals to an inaccesible location, secure the ammunition in a locked container, and send proof to LPA by email at robert.maciel@dss.ca.gov by 2/18/26.
Type B
Section Cited
CCR
102425(j)(2)
Infant Safe Sleep
The provider shall supervise infants while they are sleeping and adhere to the following requirements: The provider shall check and document the following:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview with Licensee, the licensee did not record 15-minute sleep checks for a child (C4) due to believing that they were no longer requred after the child was one year of age which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/18/2026
Plan of Correction
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Licensee stated they would begin recording 15 minute safe sleep checks for C4 and submit a copy of checks performed from 1/21/26 - 1/28/26 to LPA by email at robert.maciel@dss.ca.gov by 2/18/26.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Melchisedeck Augustin
NAME OF LICENSING PROGRAM MANAGER:
Robert Maciel
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 01/21/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/21/2026


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 01/21/2026 02:44 PM - It Cannot Be Edited


Created By: Robert Maciel On 01/21/2026 at 01:26 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
, 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: 01/21/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102418(g)
Immunizations
(g) The licensee shall document each child's immunizations as required by the California Code of Regulations, Title 17, Section 6070, and shall maintain such documentation for as long as the child is enrolled.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the facility did not possess complete immunization records for children (C2-C5) and did not possess the CDPH286 immunization record form for a child (C1) which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/18/2026
Plan of Correction
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Licensee stated they would obtain complete immunization records recorded onto the CDPH286 form for C1-C5 and send a copy to LPA by email at robert.maciel@dss.ca.gov by 2/18/26.
Type B
Section Cited
CCR
102417(m)(3)
Operation of A Family Child Care Home
(3) A file of affidavits signed by each parent with a child enrolled in the home. The affidavit shall state that the parent has been informed that the family child care home does not carry liability insurance or a bond according to standards established by the state.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the facility did not possess record of the LIC282 Affidavit Regarding Liability Insurance for children (C2-C3) which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/18/2026
Plan of Correction
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Licensee stated they would obtain signed LIC282 forms for C2 and C3 and send a copy to LPA by email at robert.maciel@dss.ca.gov by 2/18/26.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Melchisedeck Augustin
NAME OF LICENSING PROGRAM MANAGER:
Robert Maciel
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 01/21/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/21/2026


LIC809 (FAS) - (06/04)
Page: 6 of 13
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA CC RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: REYNOSO/PALMERIN FAMILY CHILD CARE HOME
FACILITY NUMBER: 233007705
VISIT DATE: 01/21/2026
NARRATIVE
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LPAs also visited for the purpose of reviewing the terms of the Stipulation and Waiver; and Order; effective on 03/19/2025. The licensee was granted probationary license subject to the following limitations and conditions:

· Respondent shall operate the facility in strict compliance with the regulations and statutes governing the operation of an FCCH.

· During the period of probation, the Department in its sole discretion may conduct unannounced site visits for the purpose of determining whether there is full compliance with the regulations and statutes governing the operation of an FCCH.

· Respondents shall ensure that all individuals working, residing or volunteering in the facility shall obtain criminal record clearances or exemptions prior to their initial presence in the facility and shall maintain proof of such criminal record clearances or exemptions at the facility.

· Respondent is required to maintain an accurate, complete, and current client roster which must be made available to the Department upon request.

· Respondents shall report to the Licensing office the following: any unusual incident including but not limited to, client death or injury which requires medical treatment, any suspected physical or psychological abuse of any client, any physical plant changes and all unexplained absences. These incidents must be reported by the next working day, and a written report of the incidents must be submitted within seven days following the occurrence of the incident.

NAME OF LICENSING PROGRAM MANAGER: Melchisedeck Augustin
NAME OF LICENSING PROGRAM ANALYST: Robert Maciel
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 01/21/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/21/2026
LIC809 (FAS) - (06/04)
Page: 12 of 13
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA CC RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: REYNOSO/PALMERIN FAMILY CHILD CARE HOME
FACILITY NUMBER: 233007705
VISIT DATE: 01/21/2026
NARRATIVE
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· For the duration of the probationary period, Respondent shall inform all current and prospective parents of children in the facility of the facility's probationary license by providing to the parents a copy of this Stipulation and the attached Accusation. Parents shall sign an acknowledgement indicating they have received a copy of the Stipulation and the attached Accusation. This parental acknowledgement shall be maintained in the corresponding child's file and shall be made available to the Department upon request.

· Respondent shall, within ninety (90) days of the adoption of this Stipulation, complete training related to the allegations contained in the Accusation and approved by licensing. The training topics must include 1) care and supervision; and 2) personal rights.

LPA review of child records revealed that children (C1 - C5) possessed signed LIC9224 Acknowledgement of Receipt of Licensing Report for the stipulation dated 3/19/25. On 5/29/25, Licensees submitted statements detailing what was learned from the supervision and personal right's training videos from https://ccld.childcarevideos.org/.



Exit interview conducted and report was reviewed with Licensee Osvaldo Palmerin. The following violations of the California Code of Regulations, Title 22; Division 12, were observed during today’s visit. See LIC 809-D. Appeal Rights were provided. 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.
NAME OF LICENSING PROGRAM MANAGER: Melchisedeck Augustin
NAME OF LICENSING PROGRAM ANALYST: Robert Maciel
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 01/21/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/21/2026
LIC809 (FAS) - (06/04)
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