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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304310216
Report Date: 04/04/2023
Date Signed: 04/04/2023 10:45:36 AM

Document Has Been Signed on 04/04/2023 10:45 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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:PALMERI, MIRNAFACILITY NUMBER:
304310216
ADMINISTRATOR:PALMERI, MIRNAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(949) 463-4544
CITY:ALISO VIEJOSTATE: CAZIP CODE:
92656
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
04/04/2023
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Mirna Palmeri, LicenseeTIME COMPLETED:
10:45 AM
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Licensing Program Analyst (LPA) Stacy Torrence conducted a case management inspection due to licensee’s request to change the facility’s status from inactive to active. According to licensing records, licensee has been on inactive status since August 2022. LPA Torrence met with Mirna Palmeri, licensee, who guided analyst on a tour of the facility. There were no daycare children present. A review of the Facility Personnel Report Summary indicates two adult residents, who require caregiver background check clearances exemptions is received and is cleared. Per applicant, there is one minor child living in the home.

The facility is a two-story home with four bedrooms, 3.5 bathrooms, living room, family room, dining room, kitchen, laundry room, front yard (not fenced), backyard (fenced), and garage. Licensee has designated the living room, family room, dining room, kitchen, .5 bathroom, and backyard as part of her day-care. The fenced backyard will be utilized for outdoor activity. Licensee has designated entire 2nd floor, front yard, side yard, and garage as the off-limit areas. Licensee has child proof gate at the bottom of the stairs, leading to the 2nd floor, ensure these areas are inaccessible to the children in care. Licensee has also placed a child proof gate at the entrance of the side yard, making this area inaccessible to children in care. The licensee acknowledged the children may never enter the off-limit areas. The licensee has a cell phone that is used for childcare. Licensee was informed and understands the home is to be free from smoking during hours of operation.



EMSA approved Pediatric CPR & Pediatric First Aid are current for the applicant and expires on 08/24. Licensee completed the 8-hour Preventative Health Practices and Nutrition Course.

The facility has a fireplace, located in the family room, barricaded by a glass cover. Cleaning solutions/chemicals are located in the garage on a top shelf. Utensils and sharp knives are located in a cabinet with safety latches, in the kitchen. There are no bodies of waters on the premises. Poisons/Hazardous items are not stored on the premises and LPA did not observe any. The toys are age appropriate and in good condition for the potential ages served. Baby walkers, bouncers, jumpers, and similar items will not be used for children in care. There are no weapons or firearms on the premises. When firearms are present, they must be locked and stored separately from the ammunition. During today's inspection, the smoke detector and carbon monoxide were operable, and the fire extinguisher was charge

SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Stacy Torrence
LICENSING EVALUATOR SIGNATURE: DATE: 04/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/04/2023
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: PALMERI, MIRNA
FACILITY NUMBER: 304310216
VISIT DATE: 04/04/2023
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The following was discussed with the applicant:
Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with applicant 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 applicant 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.

An exit interview was conducted. The report was reviewed and discussed with licensee. Appeal Rights were explained. The Licensee was provided a copy of appeal rights (LIC 9058 01/16) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the Regional Office within 15 business days. First level appeals should be sent to the regional manager to the address listed above. The Notice of Site Visit was posted and discussed as required by H&S Code Sec. 1596.817. The Notice of Site Visit must be posted on or adjacent to the door. Notice of Site Visit must be posted for 30 consecutive days. Failure to post will result in civil penalties of $100.00.
SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Stacy Torrence
LICENSING EVALUATOR SIGNATURE:

DATE: 04/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/04/2023
LIC809 (FAS) - (06/04)
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