<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 525407848
Report Date: 12/01/2025
Date Signed: 12/02/2025 12:07:49 PM

Document Has Been Signed on 12/02/2025 12:07 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, 520 COHASSET RD., SUITE 170
CHICO, CA 95926
FACILITY NAME:PALOMINOS, MARIA FAMILY CHILD CARE HOMEFACILITY NUMBER:
525407848
ADMINISTRATOR/
DIRECTOR:		PALOMINOS, MARIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(530) 433-3937
CITY:CORNINGSTATE: CAZIP CODE:
96021
CAPACITY: 14TOTAL ENROLLED CHILDREN: 11CENSUS: 11DATE:
12/01/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:10 PM
MET WITH:Maria PalominosTIME VISIT/
INSPECTION COMPLETED:
04:10 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 12/1/2025 at 2:10pm, an annual inspection was made to the facility by Licensing Program Analyst (LPA), Laura Chavez. At 2:15pm, the home was toured inside and outside. At that time, LPA observed the licensee without any assistant present, supervising 11 children, 1 infant, 2 aged 2 years, 2 aged 3, 1 aged 4, 2 aged 6, 1 aged 7, 1 aged 11, and 1 aged 12 playing in the converted garage/playroom. The facility’s operating hours are 5:30am - 5:30pm, Monday–Friday. The floor plan submitted by the licensee was reviewed and verified. The off-limits areas of the home are the 2 bedrooms, which were made inaccessible by locks and doorknob covers. The children use the backyard as the outdoor play area, and it is fully fenced. There were no pools or other bodies of water observed in the yard.

Eleven children's records were reviewed at 2:24pm. During the review of records, LPA found that the Identification and Emergency Information (LIC700), Parent Notification, Additional Children in Care (LIC9150), Consent for Medical Treatment (LIC627), and Notification of Parents’ Rights (995A) were missing for Child #1, Child #2, and Child #3. The Affidavit Regarding Liability Insurance (LIC282) was missing for Child #1, Child #2, Child #3, and Infant #4. The licensee was unable to provide proof of safe sleep documentation for Infant #4. Currently, 2 adults reside in the home.

NAME OF LICENSING PROGRAM MANAGER: Megan Aviles
NAME OF LICENSING PROGRAM ANALYST: Laura Chavez
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 12/01/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/01/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 8
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)
Page: 2 of 8
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., SUITE 170
CHICO, CA 95926
FACILITY NAME: PALOMINOS, MARIA FAMILY CHILD CARE HOME
FACILITY NUMBER: 525407848
VISIT DATE: 12/01/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
The following deficiencies were cited: 102416.5(e), 102421(b), 102421(d)(1), 102417(g)(7), 102419(d)(1), 102417(m)(3), 102425(j)(2)(D)(a)(b)(c), (see LIC 809D's):

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.



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.

LPA discussed the safe sleep regulations with licensee Maria Palominos and discussed the Child Care Licensing Safe Sleep web page 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.
NAME OF LICENSING PROGRAM MANAGER: Megan Aviles
NAME OF LICENSING PROGRAM ANALYST: Laura Chavez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 12/01/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/01/2025
LIC809 (FAS) - (06/04)
Page: 3 of 8
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., SUITE 170
CHICO, CA 95926
FACILITY NAME: PALOMINOS, MARIA FAMILY CHILD CARE HOME
FACILITY NUMBER: 525407848
VISIT DATE: 12/01/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
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/.

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

During the exit interview, the LICENSEE Maria Palominos, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the licensee Maria Palominos.
NAME OF LICENSING PROGRAM MANAGER: Megan Aviles
NAME OF LICENSING PROGRAM ANALYST: Laura Chavez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 12/01/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/01/2025
LIC809 (FAS) - (06/04)
Page: 4 of 8
Document Has Been Signed on 12/02/2025 12:07 PM - It Cannot Be Edited


Created By: Laura Chavez On 12/01/2025 at 03:31 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
, 520 COHASSET RD., SUITE 170
CHICO, CA 95926

FACILITY NAME: PALOMINOS, MARIA FAMILY CHILD CARE HOME
FACILITY NUMBER: 525407848

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/01/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102421(b)
Child's Records
(b) The licensee shall maintain, in each child's record, a copy of the emergency information card as required
in Section 102417(g)(7).

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review, the licensee did not comply with the section cited above in 3 out of 11 persons which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/31/2025
Plan of Correction
1
2
3
4
The licensee agrees to provide completed copies of the Identification and Emergency Information (LIC700) for Child #1, Child #2, and Child #3. The plan of correction shall be submitted to CCLD on or before 12/31/2025.
Type B
Section Cited
CCR
102417(g)(7)
Operation of A Family Child Care Home
(7) An emergency information card shall be maintained for each child and shall include the child's full name, telephone number and location of a parent or other responsible adult to be contacted in an emergency, the name and telephone number of the child's physician and the parent's authorization for the licensee or registrant to consent to emergency medical care.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review, the licensee did not comply with the section cited above in 3 out of 11 persons which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/31/2025
Plan of Correction
1
2
3
4
The licensee agrees to provide completed copies of Consent for Medical Attention LIC627) for Child #1, Child #2, and Child #3. The plan of correction shall be submitted to CCLD on or before 12/31/2025.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Megan Aviles
NAME OF LICENSING PROGRAM MANAGER:
Laura Chavez
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 12/01/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/01/2025


LIC809 (FAS) - (06/04)
Page: 5 of 8
Document Has Been Signed on 12/02/2025 12:07 PM - It Cannot Be Edited


Created By: Laura Chavez On 12/01/2025 at 03:31 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
, 520 COHASSET RD., SUITE 170
CHICO, CA 95926

FACILITY NAME: PALOMINOS, MARIA FAMILY CHILD CARE HOME
FACILITY NUMBER: 525407848

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/01/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102419(d)(1)
Admission Procedures and Authorized Representatives Rights
(d) At the time of acceptance of each child into care, the licensee shall provide the child's parent or authorized representative with a copy of the notice Family Child Care Home Notification of Parent's Rights, LIC 995A (8/06), the Caregiver Background Check Process, LIC 995E (6/05), and the Family child Care Consumer Awareness Information, LIC 9212 (10/05). (1) The licensee shall request the child's parent or authorized representative to sign and date the bottom portion of the notice form LIC 995A (8/06), which acknowledges that the parent or
authorized representative has received and read the LIC 995A. The bottom portion of this form
must be kept in the child’s file as proof that the parent or authorized representative has been
notified of his or her rights and received a copy of the Caregiver background Check Process, LIC
995E (6/05), and the Family Child Care Consumer Awareness Information, LIC 9212 (10/05).

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review, the licensee did not comply with the section cited above in 3 out of 11 persons which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/31/2025
Plan of Correction
1
2
3
4
The licensee agrees to provide completed copies of Notification of Parents Rights (LIC995A) for Child #1, Child #2, and Child #3. The plan of correction shall be submitted to CCLD on or before 12/31/2025.

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Megan Aviles
NAME OF LICENSING PROGRAM MANAGER:
Laura Chavez
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 12/01/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/01/2025


LIC809 (FAS) - (06/04)
Page: 6 of 8
Document Has Been Signed on 12/02/2025 12:07 PM - It Cannot Be Edited


Created By: Laura Chavez On 12/02/2025 at 11:25 AM
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
, 520 COHASSET RD., SUITE 170
CHICO, CA 95926

FACILITY NAME: PALOMINOS, MARIA FAMILY CHILD CARE HOME
FACILITY NUMBER: 525407848

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/01/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(j)(2)(D)
(a)(b)(c) - The provider shall supervise infants while they are sleeping and adhere to the following requirements: The provider shall check and document the following: date, infant’s name, and time of each 15-minute check.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on an interview with the licensee, the licensee did not comply with the section cited above in 1 out of 1 infant which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/31/2025
Plan of Correction
1
2
3
4
The licensee agrees to provide 2 weeks of the required 15 minute infant sleep documentation for Infant #4. The plan
of correction shall be submitted to CCLD on or before 12/31/2025.
Type B
Section Cited
CCR
102421(d)(1)
In any case in which the licensee cares for an additional child pursuant to Section 102416.5(b) for a Small Family Child Care Home or Section 102416.5(d) for a Large Family Child Care Home, the licensee shall maintain, in the child's record, proof of parent notification that the facility is caring for an additional child as required in Section 102416.5(h).
(1) The licensee shall maintain a completed and signed LIC 9150 (Rev. 8/14) Parental Notification Additional Children in Care, which is incorporated by reference, for this purpose.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review, the licensee did not comply with the section cited above in 3 out of 11 persons which poses
a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/31/2025
Plan of Correction
1
2
3
4
The licensee agrees to provide completed copies of the Parent Notification, Additional Children in Care (LIC9150) for
Child #1, Child #2, and Child #3. The plan of correction shall be submitted to CCLD on or before 12/31/2025.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Megan Aviles
NAME OF LICENSING PROGRAM MANAGER:
Laura Chavez
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 12/01/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/01/2025


LIC809 (FAS) - (06/04)
Page: 7 of 8
Document Has Been Signed on 12/02/2025 12:07 PM - It Cannot Be Edited


Created By: Laura Chavez On 12/02/2025 at 11:49 AM
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
, 520 COHASSET RD., SUITE 170
CHICO, CA 95926

FACILITY NAME: PALOMINOS, MARIA FAMILY CHILD CARE HOME
FACILITY NUMBER: 525407848

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/01/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102416.5(e)
If no assistant provider is present at a Large Family Child Care Home, then the licensee shall comply with the capacity requirements for a Small Family Child Care Home as specified in subsections (b) and (c).


This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on LPA's observation, the licensee did not comply with the section cited above in which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/08/2025
Plan of Correction
1
2
3
4
The licensee agrees to provide a written statement on how she will comply with the capacity requirements for a Small Family Child Care Home when an assistant is not present. The plan of correction shall be submitted to CCLD on or before 12/8/2025.
Type B
Section Cited
CCR
102417(m)(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
1
2
3
4
Based on record review, the licensee did not comply with the section cited above in 4 out of 11 persons which poses
a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/31/2025
Plan of Correction
1
2
3
4
The licensee agrees to provide completed copies of the Affidavit Regarding Liability Insurance (LIC282) for Child #1,
Child #2, Child #3, and Child #4, to CCLD on or before 12/31/2025.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Megan Aviles
NAME OF LICENSING PROGRAM MANAGER:
Laura Chavez
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 12/01/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/01/2025


LIC809 (FAS) - (06/04)
Page: 8 of 8