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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426207382
Report Date: 01/06/2025
Date Signed: 01/06/2025 03:41:04 PM

Document Has Been Signed on 01/06/2025 03:41 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, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME:PENK FCC AKA LITTLE SHINING STARSFACILITY NUMBER:
426207382
ADMINISTRATOR/
DIRECTOR:
LAUREL PENKFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 934-3958
CITY:SANTA MARIASTATE: CAZIP CODE:
93455
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 4DATE:
01/06/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:30 PM
MET WITH:Laurel PenkTIME VISIT/
INSPECTION COMPLETED:
03:50 PM
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On 1/6/2024 at 2:30 PM, Licensing Program Analyst Gigi Reyes conducted an unannounced Case Management inspection at the above Family Child Care Home. LPA met with Licensee, Laurel Penk and discussed the purpose of the inspection. LPA observed 4 children in the play area engaged with different activities under the supervision of the Licensee.

On 11/22/2024, Licensee reported an incident that occurred on 11/21/2024 involving Child # 1 (C!) . Based on the report C1 stood up on a swing and jumped off, and landed on C1's right arm, resulting in a buckled fracture. At the time of the incident there were 10 children playing outside under the supervision of two staff members.
Based on Licensee's account, while she could see C1's act, she was not in close enough proximity to intervene and prevent C1 from jumping. The swing was observed to be properly constructed, age appropriate and built under the foundation of the sand.

Child was picked up right after the incident occurred and was brought to the urgent care where C1 received medical care, including a cast. The child returned to the FCCH after 5 days. After this incident, Licensee had reinforced safety rules with children during outdoor activities.
During today's inspection no deficiency was cited. Notice of Site Visit was issued and must be posted for 30 days.

Exit interview conducted and report was reviewed with Licensee, Laurel Penk.
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Gigi Reyes
LICENSING EVALUATOR SIGNATURE: DATE: 01/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/06/2025
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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