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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197407318
Report Date: 05/20/2022
Date Signed: 05/20/2022 03:12:52 PM

Document Has Been Signed on 05/20/2022 03:12 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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:PENNY AND PEGGY NAIRN 24-HR CHILDCARE INC.FACILITY NUMBER:
197407318
ADMINISTRATOR:PEGGY NAIRNFACILITY TYPE:
850
ADDRESS:9213 COLUMBUS AVENUETELEPHONE:
(818) 892-6634
CITY:NORTH HILLSSTATE: CAZIP CODE:
91343
CAPACITY: 42TOTAL ENROLLED CHILDREN: 42CENSUS: DATE:
05/20/2022
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
09:03 AM
MET WITH:Director: Tammy JacquinTIME COMPLETED:
03:30 PM
NARRATIVE
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***** Case Management (POC) Report was not completed during the visit on 05/16/22 due to computer issues. Facility Visit Summary Report (LIC809s) was provided and signed by the Administrator Tammy Jacquin in lieu of Case Management Report (LIC809). *****

On 05/20/22, at 9:03 a.m., Antonio Almanza, Licensing Program Analysts Conducted a subsequent unannounced visit, to the visit conducted on On 5/16//22. The purpose of the visit is to clear Plan of Corrections (POCs) for citations issues on 04/14/2022. LPA met with Director Tina Roberts and Administrator Tammy Jacquin, explained the purpose of the visit, and toured that facility. During today’s visit there were 2 adults providing care and supervision to 8 children in care.

LPA Cleared 6 POCs for violations issued and POC letters were generated and provided to the Director. The following repeat violation is being cited under Title 22 Regulations, Division 12, Chapter 1, of the California Code of Regulations, and Health & Safety Code (please see LIC 809-Ds for cited deficiencies).

1. Per Stipulation Licensee shall provide 24 hours of quarterly training to staff on mental health assessments, client behaviors, personal rights, care and supervision, and medication and keep a record of staff who attend such training and make records available to Licensing. During todays visit LPA went through the 24-hour training that has been provided to the department with Owner Peggy Nairn. Peggy verified that the training is incomplete based on the documents provided by Peggy as proof of the 24 hours of training required per the Stipulation.

During today’s visit the following two (2) Type B violations were observed and are being cited under Title 22 Regulations, Division 12, Chapter 1, of the California Code of Regulations, and Health & Safety Code (please see LIC 809-Ds for cited deficiencies).



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SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Antonio Almanza
LICENSING EVALUATOR SIGNATURE: DATE: 05/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/17/2022
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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: PENNY AND PEGGY NAIRN 24-HR CHILDCARE INC.
FACILITY NUMBER: 197407318
VISIT DATE: 05/20/2022
NARRATIVE
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1. During today’s visit LPA observed 8 children in care. When LPA reviewed the sign in sheet, LPA observed 9 children signed in. LPA had the Director review the sign in sheet and explain the discrepancy. The director was able to identify Child 1 as being enrolled at the Dearborn facility (197407811) and not present at the Columbus facility (197407318). LPA observed that Child 2 is in the classroom but there is no time of arrival documented in the sign in sheet.

2. During todays visit while conducting a walk through of the classroom, LPA observed a bottle of hand sanitizer next to the children’s bathroom accessible to children on top of small cabinet, and another bottle of hand sanitizer on top of cabinet accessible to children inside the classroom next to the entrance. LPA notified the Director and the Director asked Staff 1 to remove the hand sanitizers and make them inaccessible to children.

*** A copy of facility license was provided during todays visit.

*** Repeat violation assessed on LIC421FC for $250.

A copy of this Report (809) and LIC 9213 Notice of Site Visit was provided to the Director Tina Roberts and Administrator Tammy. Director was advised that LIC 9213 Notice of Site Visit is required to be posted for 30 days. Failure to maintain posting as required will result in a civil penalty of $100.00.

A copy of this Report (809 & 809Ds), Notice of Site Visit, and Appeal Rights were explained and provided to the Director Tina Roberts and Administrator Tammy Jacquin. This report shall be made available to the public upon request.

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SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Antonio Almanza
LICENSING EVALUATOR SIGNATURE:

DATE: 05/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/20/2022
LIC809 (FAS) - (06/04)
Page: 2 of 4
Document Has Been Signed on 05/20/2022 03:12 PM - It Cannot Be Edited


Created By: Antonio Almanza On 05/20/2022 at 02:15 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: PENNY AND PEGGY NAIRN 24-HR CHILDCARE INC.
FACILITY NUMBER: 197407318

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/20/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/30/2022
Section Cited
CCR
101216(e)

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101216 Personnel Requirements (e) All personnel shall be given on-the-job training... Per Stipulation Licensee shall provide 24 hours of quarterly training and keep a record of staff who attend such training and make records available to Licensing.
This requirement is not met as evidenced by:
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Licensee shall comply with the Stipulation and Waiver; and Order, and provide the 24 hours of training to staff and submit a copy of the records of staff who attended the training on required subjects, to LPA by 05/30/22.
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Based on observation and records review, per stipulation the Licensee does not meet the requirements of the 24 hours of quarterly training, which poses a potential Health or Safety, or personal rights risk to persons in care.
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Type B
05/30/2022
Section Cited
CCR101229.1(a)(1)

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101229.1 Sign In and Sign Out (a)(1)The person who signs the child in/out shall use his/her full legal signature and shall record the time of day.

This requirement is not met as evidenced by:
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Director will provide Staff and Parents with reminder that person who brings the child, and removes the child from the center shall sign the child in and out and put time. Director will provide copy of memo provided to parents and staff sign of acknowlegeing receipt of instructions.
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Based on observation and records review, Child , which poses a potential Health or Safety, or personal rights risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Lisa Rios
LICENSING EVALUATOR NAME:Antonio Almanza
LICENSING EVALUATOR SIGNATURE:
DATE: 05/20/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/20/2022


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 05/20/2022 03:12 PM - It Cannot Be Edited


Created By: Antonio Almanza On 05/20/2022 at 02:29 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: PENNY AND PEGGY NAIRN 24-HR CHILDCARE INC.
FACILITY NUMBER: 197407318

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/20/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/30/2022
Section Cited
CCR
101238(g)

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101238 Buildings and Grounds,
(g) Disinfectants, cleaning solutions, poisons and other items that could pose a danger if readily available to children shall be stored where inaccessible to children.

This requirement is not met as evidenced by:
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Director had the handsanitizers removed by Staff 1 and will write memo to staff to make sure to make handsanitizer inaccesible to children at all times.
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Based on observation hand sanitizer was accessible to children next to the bathroom and in the entrance of the classroom, which poses a potential Health or Safety, or personal rights risk to persons in care.
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Director will provide copy of memo with sign of by teachers by 05/30/22

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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Lisa Rios
LICENSING EVALUATOR NAME:Antonio Almanza
LICENSING EVALUATOR SIGNATURE:
DATE: 05/20/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/20/2022


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