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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197407318
Report Date: 09/15/2022
Date Signed: 09/15/2022 10:35:52 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/30/2022 and conducted by Evaluator Antonio Almanza
PUBLIC
COMPLAINT CONTROL NUMBER: 30-CC-20220630092326
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:42CENSUS: 7DATE:
09/15/2022
UNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Director Tina RobertsTIME COMPLETED:
10:50 AM
ALLEGATION(S):
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9
Neglect/Lack of Supervision - Child received an injury while in care
INVESTIGATION FINDINGS:
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On 09/15/2022 at 9:11 a.m., Antonio Almanza, Licensing Program Analyst (LPA), conducted an unannounced site visit for the purpose of delivering finding for complaint received on 06/30/2022. LPA met with Tina Roberts, Director, and explained the purpose of the visit. During today’s visit there are 2 Adults and 7 Children in care. Risk Assessment was completed prior to conducting visit.

During the course of the investigation, LPA Almanza conducted interviews and reviewed records regarding the aforementioned allegations.

The parent of the child who sustained an injury while in care is reporting that parent was notified of the incident and signed the incident report. The parent is reporting that the child received a bump to the forehead that turned into a bruise.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Antonio Almanza
LICENSING EVALUATOR SIGNATURE:

DATE: 09/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2022
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 2
Control Number 30-CC-20220630092326
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: PENNY AND PEGGY NAIRN 24-HR CHILDCARE INC.
FACILITY NUMBER: 197407318
VISIT DATE: 09/15/2022
NARRATIVE
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The facility is reporting that the child sustained an injury while in care. Staff 5 is reporting that Staff 5 did not observe the incident but sent the parent a text message with a picture of the child notifying the parent that the child sustained an injury. Staff 6 wrote the Incident Report that was given to the parent of the child. According to the incident report the child tripped over the child’s own shoes which caused the child to fall face first. LPA has not been able to make contact with Staff 6.

Based on the evidence obtained, LPA is unable to determine if the child was properly supervised at the time of the incident. Therefore, the allegation is determined Unsubstantiated. A finding that the complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the allegation occurred.

A copy of this report, Notice of Site Visit, and Appeal Rights were explained and provided to the Director Tina Roberts and Administrator Tammy Jacquin.

SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Antonio Almanza
LICENSING EVALUATOR SIGNATURE:

DATE: 09/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2