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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 013422425
Report Date: 08/10/2022
Date Signed: 08/12/2022 07:32:05 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/03/2022 and conducted by Evaluator Simerjit Kaur
PUBLIC
COMPLAINT CONTROL NUMBER: 52-CC-20220803112634
FACILITY NAME:KIDDIE ACADEMYFACILITY NUMBER:
013422425
ADMINISTRATOR:BRUCE, SHANNONFACILITY TYPE:
850
ADDRESS:1400 N. VASCO RD.TELEPHONE:
(925) 292-1948
CITY:LIVERMORESTATE: CAZIP CODE:
94551
CAPACITY:120CENSUS: 21DATE:
08/10/2022
UNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Ebonee LuceroTIME COMPLETED:
03:45 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Record Keeping- Staff files are incomplete
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analysts (LPAs) Simerjit Kaur and Julia Placencia arrived at the facility unannounced to conduct an investigation into the above allegation. LPAs met with Assistant Director Ebonee Lucero. Present during today's inpection were 21 preschool aged children and 3 staff members.
During the course of the investigation, LPAs conducted interviews and record review. Based on record review, the facilty have incomplete staff files in the preschool age component. The allegation that the staff files are incomplete has been SUBSTANTIATED. Based on evidence gathered, the standard has been met, therefore the above allegation is found to be SUBSTANTIATED.
See attached LIC 9099D. A copy of this report, and Appeal Rights provided.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Simerjit Kaur
LICENSING EVALUATOR SIGNATURE:

DATE: 08/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/10/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
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