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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434415987
Report Date: 12/20/2022
Date Signed: 12/20/2022 04:03:33 PM

Document Has Been Signed on 12/20/2022 04:03 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: 3DATE:
12/20/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Kaitlynn Pennington TIME COMPLETED:
04:00 PM
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Licensing Program Analyst (LPA) Elizabeth Larios met with Kaitlynn Pennington, Licensee, for an unannounced Required – 1 year annual inspection. LPA was granted access to the home by the Licensee. LPA also observed three day care children. Licensee was operating within her capacity and ratio requirements. LPA observed the required postings, including the facility license, near the front entrance to the home. Days and hours of operation are Monday - Friday from 7:30 AM to 5:00 PM. Licensee's and spouse are the only adults residing in the home.

LPA reviewed a current Child Care Facility Roster.Facility is not conducting fire/disaster drills. Licensee's do have liability insurance for the day care (expiration: 5/11/2023). Licensee's do not have current CPR and First Aid certifications (expiration: October 2022). Licensee's has the required vaccines (MMR, Tdap, & flu). Licensee Kristina does not have a current Mandated Reporter Training for Child Care Workers Certificate (expiration: September 28, 2022). LPA reviewed three children's files and the files were incomplete with the required forms (immunization).

LPA toured the indoor and outdoor areas of the home during today's inspection. Licensee's have a working telephone in the home. The home is clean, orderly, (including heating/fans/ventilation), and safe for the day care children. There are safe & age appropriate toys, play equipment, and materials for the children in the home. LPA observed barricade fireplace in living room. The off limit areas in the home is the master bedroom/bathroom, garage, and front yard. Backyard was observed fenced, and no bodies of water were observed.

LPA observed two fully charged 2A10BC fire extinguisher in the laundry room, hallway, and kitchen. Facility has a working smoke/carbon monoxide detectors. The Licensee stated that there are no weapons/ firearms in the home. All detergents, cleaning compounds, medications, and other similar items are inaccessible to children. Licensee states that she does not administer any medications to the day care children at this time.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Elizabeth Larios
LICENSING EVALUATOR SIGNATURE: DATE: 12/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/20/2022
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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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: 12/20/2022
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No deficiencies cited during todays inspection, exit interview conducted with Licensee's Kristina & Kaitlynn Pennington and a copy of this report was provided.

The annual inspection will be continued on a later date.


A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE ENTRANCE TO THE FACILITY, AND MUST REMAIN POSTED FOR 30 DAYS.

SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Elizabeth Larios
LICENSING EVALUATOR SIGNATURE:

DATE: 12/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2022
LIC809 (FAS) - (06/04)
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