<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434415987
Report Date: 07/26/2021
Date Signed: 07/26/2021 11:58:42 AM

Document Has Been Signed on 07/26/2021 11:58 AM - 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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:PENNINGTON, KRISTINA & KAITLYNNFACILITY NUMBER:
434415987
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 3DATE:
07/26/2021
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Pennington, Kristina & Kaitlyn TIME COMPLETED:
12:15 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On this day, Licensing Program Analyst (LPA) Almaraz, Celi conducted an announced pre-licensing visit with applicant Pennington, Kristina. LPA explained the nature of this inspection. The hours of operation of the will be as follows: 7:30 AM to 4:30 PM, Monday through Friday. The adults that reside in the home are as follows: Applicant, co-applicant Pennington, Kaitlyn and spouse/father Pennington, Dan. The applicants 3 grandchildren were present.

Physical Plant: LPA Almaraz toured the indoor and outdoor areas of the home during today's visit. LPA observed the following: Off limit areas inside are as follows: One master bedroom/bathroom, one bedroom and one bathroom. The garage. There is a play room area upon entry to the home, to the right. Applicant will install a gate for best practice. LPA discussed getting safety knobs for one master bedroom and a separate bath room, the other off limits bedroom is inaccessible by a door code with a knob. LPA discussed getting a safety knob for the door in the laundry room area, which is where children's bathroom will be, that leads to the garage area. LPA also asked applicant to get a deterrent for hall closet. There are two bedrooms that will be used for day care, LPA has asked applicant to remove all lotions, medications, alcohol and other items that may pose a risk to children in care. Applicant will remove items. LPA asked applicant to get a safety device for kitchen drawer that has knives and to move knives from counter and place them in a more inaccessible area. Off limit areas outside the home are as follows: The entire back yard, due to construction. LPA has asked for safety device for this area until all hazards removed and it is on limits. Applicant states this will be made accessible once construction is complete and will notify licensing. Licensing will return to inspect backyard and update sketch. LPA was unable to tour due to construction. Children will go to nearby park.1/3
SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Araceli Almaraz
LICENSING EVALUATOR SIGNATURE: DATE: 07/26/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/26/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: PENNINGTON, KRISTINA & KAITLYNN
FACILITY NUMBER: 434415987
VISIT DATE: 07/26/2021
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
There is a fully charged 3A40BC fire extinguisher purchased 07/14/2021. There is at least one working smoke/carbon monoxide detector. LPA did not observe and applicant states there is none of the following on the premises: Bodies of water, wall heaters and/or weapons. There is a firepalce that needs to be barricaded. Applicant/s state there are 3 pets total, one dog and two cats, all vaccinated. Applicant understands the following: Cleaning products, toxic agents, medications, and sharp objects shall not be accessible to children. Poisons must be locked.
LPA observed cleaning products, poisons and toxic agents are all not yet locked, applicant will make inaccessible.

LPA Almaraz discussed the importance of maintain files for children including keeping records at least three years from separation. LPA also discussed the importance of maintaining records for any person/assistant providing care to the children. Applicants completed Mandated Abuse Reporter Training on 09/28/2020 and 02/23/2021; First Aid and CPR both valid until 02/23/2022. Applicants have proof of required immunization's and proof of flu vaccine. LPA observed TB tests for all adults in the home. Applicants own home. Does not have liability insure. A copy of property tax bill for home is on licensing file, as are all required records observed by LPA.

LPA informed the applicant of the following: A fire/disaster drills must be practiced at least once every 6 months and documented. The required postings. Changes made to the home must be reported to the department and submitted for approval. A Family Child Care Home packet with updated Licensing forms has been emailed to and reviewed with applicant prior to inspection, as were RAST protocols. The importance of maintaining a roster for the children in care was discussed. Applicant understands the importance of maintaining social distancing and adhering to other covid safety protocols.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. 2/3
SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Araceli Almaraz
LICENSING EVALUATOR SIGNATURE:

DATE: 07/26/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2021
LIC809 (FAS) - (06/04)
Page: 2 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: PENNINGTON, KRISTINA & KAITLYNN
FACILITY NUMBER: 434415987
VISIT DATE: 07/26/2021
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Forms of discipline applicant/s will use: Communication with children and redirection. Applicant/s understand that children's personal rights should not be violated; including no corporal punishment. Isolation of sick children, unusual incidents/injuries, heat related illnesses, and requirements for assistant/substitute were also discussed. Applicant/s state there may be transporting of children and understands the laws regarding child care transportation, including car seat and the valid/good standing drivers license requirements.

LPA advised applicant of the Department regulation update re: safe sleep for infant children. LPA referred the applicant to the Department website: www.ccld.ca.gov and www.safekids.org
LPA conducted an exit interview with the applicant and advised that a Small Family Child Care Home License will be approved pending the following: 1. Applicant will install a gate in play area for best practice. 2. Place safety knobs for one master bedroom/bathroom and a separate bath room and garage door in laundry room area and hall closet. 3. The two bedrooms that will be used for day care, will have all lotions, medications, alcohol and other items that may pose a risk to children in care removed. 4. applicant to get a safety device for kitchen drawer that has knives and move knives from counter and place them in a more inaccessible area. 5. A safety device for sliding door that leads to back yard. 6. Barricade for fire place. Once complete applicant will send proof via photos to Licensing, or LPA may return and an approval from a manager of the Licensing Department will be required. Report was also read to co-applicant, who signed pages 2-3 of report.

LPA referred applicant/s to keep up to date with PINS on the department website and current ongoing updates on COVID department protocols and guidelines. 3/3
SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Araceli Almaraz
LICENSING EVALUATOR SIGNATURE:

DATE: 07/26/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2021
LIC809 (FAS) - (06/04)
Page: 3 of 3