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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434415987
Report Date: 07/12/2022
Date Signed: 07/15/2022 05:28:42 PM

Document Has Been Signed on 07/15/2022 05:28 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, 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: 8CENSUS: 4DATE:
07/12/2022
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Kristina & Kaitlynn Pennington TIME COMPLETED:
11:35 AM
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Licensing Program Analysts (LPA) Elizabeth Larios met with Kristina & Kaitlynn Pennington, Licensee, to conduct an unannounced Case Management inspection. LPA also observed Licensee's spouse/father Dan during today's inspection. LPA also observed four children (one infant and three toddlers) in care. Purpose of today's visit was to inspect the back yard where construction has been completed and will be accessible to children in care. LPA inspected the backyard and observed items that need to be removed and locked due to them being hazardous to children in care. There were no bodies of water observed. Licensee's will removing all hazardous items in backyard, adding a fence that is at least five feet high in the right side of the yard that is locked, and submit a updated LIC 999 Facility Sketch to reflect the changes. Licensee's will notify licensing once backyard is ready for inspection. Backyard will remain off limits to children in care until approve.

Exit interview conducted and report was reviewed with the Licensee, Kaitlynn Pennington. No deficiencies issued during today's inspection. A Notice of Site Visit must remain posted for 30 days.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Elizabeth Larios
LICENSING EVALUATOR SIGNATURE: DATE: 07/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/12/2022
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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