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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197407318
Report Date: 05/16/2022
Date Signed: 05/16/2022 01:06:35 PM

Document Has Been Signed on 05/16/2022 01:06 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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:PENNY AND PEGGY NAIRN 24-HR CHILDCARE INC.FACILITY NUMBER:
197407318
ADMINISTRATOR:PEGGY NAIRNFACILITY TYPE:
850
ADDRESS:9213 COLUMBUS AVENUETELEPHONE:
(818) 892-6634
CITY:NORTH HILLSSTATE: CAZIP CODE:
91343
CAPACITY: 42TOTAL ENROLLED CHILDREN: 42CENSUS: 13DATE:
05/16/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:21 PM
MET WITH:Administrator: Tammy JacquinTIME COMPLETED:
01:07 PM
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On 5/16/22 at 9:13 a.m., Licensing Program Analysts (LPA) Antonio Almanza conducted an investigation regarding a self reported Unusual Incident Report (UIR) that occurred on 05/09/22. LPA met with Administrator Tammy Jacquin and explained the purpose of the site visit. LPA toured the facility and observed 13 children and 2 Adults present at the time of the inspection.

During todays visit LPA conducted interviews and reviewed records regarding the Director, Staff 1 no longer working at the facility. The facility was given notice by the Director regarding intent to quit effective 05/30/22. Due to personal issues the Director quit on 05/09/22. The facility has Staff 2 designated to act on behalf of the Director on LIC308, Designation of Responsibility. The new facility Director will start May 18, 2022.

During todays visit, there are no violations of Title 22 Regulations or Helath & Safety code.

A copy of this Report and Notice of Site visit were provided to the Administrator Tammy Jacquin.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Antonio Almanza
LICENSING EVALUATOR SIGNATURE: DATE: 05/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/16/2022
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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