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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 573615888
Report Date: 05/14/2024
Date Signed: 05/14/2024 02:13:44 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/20/2024 and conducted by Evaluator Corina Beckby
COMPLAINT CONTROL NUMBER: 53-CC-20240220163116
FACILITY NAME:PALAFOX, EVAFACILITY NUMBER:
573615888
ADMINISTRATOR:PALAFOX, EVAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(530) 321-9690
CITY:WEST SACRAMENTOSTATE: CAZIP CODE:
95605
CAPACITY:14CENSUS: 6DATE:
05/14/2024
UNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Eva PalfoxTIME COMPLETED:
02:30 PM
ALLEGATION(S):
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1) Lack of Supervision
2) License
INVESTIGATION FINDINGS:
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On 05/14/24, Licensing Program Analyst (LPA) Corina Beckby conducted an unannounced complaint investigation to deliver the findings for the above allegations. LPA met with Licensee, Eva Palafox. Throughout the course of the investigation, LPA conducted physical plant inspections, on-site observations, and interviews. LPA reviewed and collected documentation pertaining to the allegations.
It was alleged that a lack of supervision resulted in daycare children wandering away from the facility.

Interviews revealed that on 02/20/2024, a child exited the facility through an unlocked door and screen and walked towards the street while the large iron gate was open. Licensee left an uncleared adult alone with children while she picked up children from school. A parent saw the incident and stopped the child from entering the street.

Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Corina Beckby
LICENSING EVALUATOR SIGNATURE:

DATE: 05/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2024
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
Control Number 53-CC-20240220163116
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: PALAFOX, EVA
FACILITY NUMBER: 573615888
VISIT DATE: 05/14/2024
NARRATIVE
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page 2...

****THIS IS AN AMENDED REPORT****

Based on interviews and Licensee’s admission, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED.

It was alleged that day care children enter the off-limit areas (bedrooms).

On 2/22/24 LPA observed a day care child enter the back bedroom, which is off limits. On 5/2/24, LPA observed children entering and coming out of the shed in the back yard, which is off limits and should be locked. Interviews revealed children have entered and have been seen in different bedrooms and the shed.

Based on clear corroborating evidence to support the allegation that children are allowed to wander into off limit areas, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED.

Title 22 deficiencies are cited on the subsequent page of this report. Licensee acknowledges, that for TYPE A DEFICIENCIES ONLY upon receipt, Licensee shall post LIC 9099-D with Type A deficiencies for 30 days and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. LIC 9224 must be signed by parents/guardians and kept with the children's forms as a receipt whenever any Type A documents are provided by the Licensee. LIC 9224 and Appeal Rights were provided. An exit interview was conducted, and a Notice of Site Visit posted which must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Corina Beckby
LICENSING EVALUATOR SIGNATURE:

DATE: 05/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 53-CC-20240220163116
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: PALAFOX, EVA
FACILITY NUMBER: 573615888
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/14/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/15/2024
Section Cited
CCR
102417(a)
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102417 Operation of a Family Child Care Home (a) The licensee...shall ensure that children in care are supervised at all times.This requirement is not met as evidenced by:
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Licensee will watch training video “Supervising Children In Family Child Care". Licensee will write a statement acknowledging she watched the video,and will only leave children with qualified
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Based on interviews conducted and record reviews, Licensee admits she left children with an uncleared adult while she picked up children from school, which poses/posed an immediate health and safety, or personal rights risk to persons in care.
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assistant if needed to maintain ratio. Licensee will date, sign and submit statement to the department by POC due date via email. Licensee will place gate to separate play area from front door.
Type B
06/17/2024
Section Cited
CCR
102416.3(a)(6)
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Alterations to Existing Buildings or Grounds(a) Prior to making alterations... the licensee shall notify the Department of the proposed changed...(6)Any change from an area of the family
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Off limit areas will be inaccessible to children via closed doors, gates, and supervision. Licensee will watch Locks and Inaccesibilty video on department website. LPA provided TSP brochure in Spanish.
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child care home previously identified as "off limits" to an area where care and supervision will be provided to children in care. .This requirement is not met as evidenced by: LPA witnessed children in off limit areas and interviews stated the children are in different bedrooms.
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LPA will write a statement stating she watched the video and understands off limit areas are to be secured, sign and date.The statement will be sumbitted via email by due date.
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: Bettina Engelman
LICENSING EVALUATOR NAME: Corina Beckby
LICENSING EVALUATOR SIGNATURE:

DATE: 05/14/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/20/2024 and conducted by Evaluator Corina Beckby
COMPLAINT CONTROL NUMBER: 53-CC-20240220163116

FACILITY NAME:PALAFOX, EVAFACILITY NUMBER:
573615888
ADMINISTRATOR:PALAFOX, EVAFACILITY TYPE:
810
ADDRESS:941 SHARIAN STREETTELEPHONE:
(530) 321-9690
CITY:WEST SACRAMENTOSTATE: CAZIP CODE:
95605
CAPACITY:14CENSUS: DATE:
05/14/2024
UNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Eva PalfoxTIME COMPLETED:
02:30 PM
ALLEGATION(S):
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9
1) Personal Rights
2) Ratio
INVESTIGATION FINDINGS:
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On 05/14/24, Licensing Program Analyst (LPA) Corina Beckby conducted an unannounced complaint investigation to deliver the findings for the above allegations. LPA met with Licensee, Eva Palafox. Throughout the course of the investigation, LPA conducted physical plant inspections, on-site observations, and interviews. LPA reviewed and collected documentation pertaining to the allegations.

It was alleged that children are left in wet clothing and in clothing inadequate for weather conditions.
Parent interviews were inconsistent with the allegation. Parents stated they’ve picked up children with dry clothes but wet hair, wet clothes but was told the children had just finished playing with water outside. Another parent stated Licensee has extra clothes
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Corina Beckby
LICENSING EVALUATOR SIGNATURE:

DATE: 05/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 53-CC-20240220163116
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: PALAFOX, EVA
FACILITY NUMBER: 573615888
VISIT DATE: 05/14/2024
NARRATIVE
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page 2...

for children and has provided a jacket for cold weather. On 5/2/24, LPA witnessed 2 children with no socks or shoes, playing in the backyard. All parents stated the children love to be at Licensee’s and don’t want to leave and are happy with the care provided.
Based on lack of clear corroborating evidence, the above allegation could not be substantiated or dismissed. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur; therefore, the finding is UNSUBSTANTIATED.

It was alleged that ratio requirements are not being met.

Licensee has 1 daughter as her only cleared assistant. LPA reviewed the schedule that was orally given to LPA and saw that at the time of the incident, Licensee may have been over ratio by 1 infant, while caring for up to 8 children. Licensee does not have a sign in and out sheet to show how many kids are attending on a daily basis. Interview with parents did not suggest an overcapacity issue. Licensee states she only has her daughter come over when needed. LPA visited the facility 3 times during the investigation and did not witness Licensee being out of ratio. Licensee was reminded that children are not to be awaken from their sleep to pick up children. Licensee stated the children wake up on their own. Licensee was given a template to keep track of the children’s schedule.

Based on lack of clear corroborating evidence, the above allegation could not be substantiated or dismissed. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur; therefore, the finding is UNSUBSTANTIATED.



An Exit interview was conducted, and the report was reviewed with Licensee, Eva Palafox. LPA posted a notice of site visit. Licensee understands the Notice must remain posted for 30 days and that a failure to comply with posting requirements shall result in an immediate civil penalty of $100. Appeal Rights were provided. A copy of this report will remain on file for a period of three years for public review upon request. The licensee's signature on this form acknowledges receipt of this form.
SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Corina Beckby
LICENSING EVALUATOR SIGNATURE:

DATE: 05/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 5