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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 04:04:22 PM

Document Has Been Signed on 12/20/2022 04:04 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:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Kaitlynn Pennington TIME COMPLETED:
11:15 AM
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Licensing Program Analysts (LPA) Elizabeth Larios met with Kaitlynn Pennington, Licensee, to conduct an unannounced Case Management inspection. LPA also observed three children (two toddlers, and one preschooler) 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. Licensee removed items to a inaccessible area for children in care. There were no bodies of water observed. Licensee provided LPA a updated LIC 999 Facility Sketch to reflect the changes to the backyard during visit. Backyard has been granted for approval.

Exit interview conducted and report was reviewed with the Licensee, Kristina & 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: 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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