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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197407812
Report Date: 08/17/2022
Date Signed: 08/17/2022 03:16:21 PM

Document Has Been Signed on 08/17/2022 03:16 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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:PENNY AND PEGGY NAIRN 24 HOUR CHILD CARE INC.FACILITY NUMBER:
197407812
ADMINISTRATOR:PEGGY & PENNY NAIRNFACILITY TYPE:
840
ADDRESS:15300 DEARBORNTELEPHONE:
(818) 892-6635
CITY:NORTH HILLSSTATE: CAZIP CODE:
91343
CAPACITY: 15TOTAL ENROLLED CHILDREN: 62CENSUS: 1DATE:
08/17/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:50 PM
MET WITH:Assistant Director Jacqueline Quiroa & Administrator Gabrielle HoveyTIME COMPLETED:
03:25 PM
NARRATIVE
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On 08/17/2022 at 9:00 a.m., Deborah Lowe and Antonio Almanza, Licensing Program Analysts (LPAs), conducted an unannounced site visit for the purpose of investigating UIR report. LPAs met with Assistant Director Jacqueline Rodriguez (Quiroa) and Administrator Gabrielle Hovey; LPAs explained the purpose of the visit. During today’s visit there is 1 child and 1 adult providing care and supervision.

LPA Almanza conducted interviews and reviewed documents regarding Incident that occurred on 08/14/2022.

On 08/14/2022 at 10:30 p.m., the Fire Department responded to an automatic alarm. The fire alarm was found to be in a “trouble state” and the firefighters were unable to get a positive reset while on scene. During this time there were 3 infant children in care. The Facility failed to notify the El Segundo Childcare Regional Office of the Unusual Incident within the next working day.

After considering available information the Facility failed to notify the El Segundo Childcare Regional Office of the Unusual Incidents within the next working day.

During today’s visit One Type B violation is being issued under Title 22 Regulations, Division 12, Chapter 1, of the California Code of Regulations: 101212 Reporting Requirements (d) Upon the occurrence, during the operation of the child care center of any of the events specified in (d)(1) below, a report shall be made to the Department by telephone or fax within the Department's next working day and during its normal business hours. In addition, a written report containing the information specified in (d)(2) below shall be submitted to the Department within seven days following the occurrence of such event.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00. A copy of this report, Appeal Rights (LIC9058) and Notice of Site Visit were reviewed and provided to the Assistant Director Jacqueline Rodriguez (Quiroa) and Administrator Gabrielle Hovey.

SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Antonio Almanza
LICENSING EVALUATOR SIGNATURE: DATE: 08/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/17/2022
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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Document Has Been Signed on 08/17/2022 03:16 PM - It Cannot Be Edited


Created By: Antonio Almanza On 08/17/2022 at 02:09 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
, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: PENNY AND PEGGY NAIRN 24 HOUR CHILD CARE INC.
FACILITY NUMBER: 197407812

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/17/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/26/2022
Section Cited
CCR
101212(d)

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101212(d) Reporting Requirements, Upon the occurrence... a report shall be made to the Department by telephone or fax within the Department's next working day and during its normal business hours...
This Requirement is not met as evidenced by:
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Licensee will provide retraining to directors on reporting requirements and provide Licensing with proof by 08/26/22.
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Based on observation, interview and record review, The facility did not report the Incidents to CCLD, which poses a potential Health or Safety, or personal rights risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Rita Ramos
LICENSING EVALUATOR NAME:Antonio Almanza
LICENSING EVALUATOR SIGNATURE:
DATE: 08/17/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/17/2022


LIC809 (FAS) - (06/04)
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