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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197407811
Report Date: 03/25/2022
Date Signed: 03/25/2022 06:16:32 PM


Document Has Been Signed on 03/25/2022 06:16 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 HOUR CHILD CARE INC.FACILITY NUMBER:
197407811
ADMINISTRATOR:PEGGY & PENNY NAIRNFACILITY TYPE:
850
ADDRESS:15300 DEARBORNTELEPHONE:
(818) 892-6635
CITY:NORTH HILLSSTATE: CAZIP CODE:
91343
CAPACITY:25CENSUS: 16DATE:
03/25/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
04:48 PM
MET WITH:Gloria Avina/DirectorTIME COMPLETED:
06:30 PM
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On 03/25/2022 at 4:25 p.m., Licensing Program Analysts (LPAs) Silva Garibyan and Antonio Almanza conducted an unannounced Case Management Visit at the Probationary Licensed Facility for the purpose of following up on the unusual incident that occurred at the facility on 03/21/2022. During today’s visit LPAs met with the Director, Gloria Avina, explained the purpose of the visit, and toured the facility. During today’s visit there are 2 adults providing care and supervision to 16 children in care.

During the inspection, LPA's conducted interviews with facility staff involved and Child 1. LPAs also reviewed child’s record and were supplied with copies of supporting documents.


During this visit, LPAs obtained a copy of the child's records.

At this time, further investigation is needed.

Exit interview conducted with director, Gloria Avina and a copy of this report was provided.
SUPERVISOR'S NAME: Mary RuizTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Silva GaribyanTELEPHONE: (424) 301-3062
LICENSING EVALUATOR SIGNATURE:
DATE: 03/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/25/2022
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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