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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 013422427
Report Date: 06/15/2021
Date Signed: 06/15/2021 12:57:35 PM

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
05/19/2021 and conducted by Evaluator Jaylena Miller
PUBLIC
COMPLAINT CONTROL NUMBER: 52-CC-20210519140613
FACILITY NAME:KIDDIE ACADEMYFACILITY NUMBER:
013422427
ADMINISTRATOR:BRUCE, SHANNONFACILITY TYPE:
830
ADDRESS:1400 N. VASCO RD.TELEPHONE:
(925) 292-1948
CITY:LIVERMORESTATE: CAZIP CODE:
94551
CAPACITY:24CENSUS: 60DATE:
06/15/2021
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Marquita GladneyTIME COMPLETED:
01:15 PM
ALLEGATION(S):
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7
8
9
Infant sustained an injury while in care
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 06/15/2021 Licensing Program Analyst (LPA) Jaylena Miller conducted an unannounced subsequent complaint investigation at the facility. LPA met with Director Marquita Gladney and explained the purpose of today’s inspection. The finding for the above allegation was delivered during the visit.
During the investigation the department conducted a physical plant inspection, reviewed facility records, and conducted interviews. During LPA record review and staff interviews it revealed that an incident occurred on 05/17/2021 where C1 was climbing on the shelves, fell and hurt his lower lip that caused slight bleeding. Based on LPA observation and interviews which were conducted and record reviews, the preponderance of evidence standard has been met, therefore the above allegation is to be SUBSTSNTIATED. As a result, and per California Code of Regulations, Title 22, Division 12, Chapter 1 Section 101429(a)(1) and a Type A deficiency is being cited.
The director must post this report for thirty days. The director must give each parent of the children in care and future parents of newly enrolled children, for the next one year following today’s date, a copy of this report. Parents are to sign an LIC 9224-Acknowledgment of Receipt of Licensing reports and this form shall be placed in each child’s file. Failure to post report and or provide a copy of this report to parent’s/authorized guardians can result in additional monetary assessments to the facility.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Jaylena Miller
LICENSING EVALUATOR SIGNATURE:

DATE: 06/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/15/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 8
Control Number 52-CC-20210519140613
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: KIDDIE ACADEMY
FACILITY NUMBER: 013422427
VISIT DATE: 06/15/2021
NARRATIVE
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This report must remain on file for three years. The director was provided a copy of their appeal rights (LIC 9058 12/15) and their signature on this form acknowledges receipt of these rights. Notice of site visit was provided and must be posted for 30 days. Exit interview conducted with director, Marquita Gladney.

Please see LIC 9099-D for deficiency cited
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Jaylena Miller
LICENSING EVALUATOR SIGNATURE:

DATE: 06/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/15/2021
LIC9099 (FAS) - (06/04)
Page: 8 of 8
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
05/19/2021 and conducted by Evaluator Jaylena Miller
PUBLIC
COMPLAINT CONTROL NUMBER: 52-CC-20210519140613

FACILITY NAME:KIDDIE ACADEMYFACILITY NUMBER:
013422427
ADMINISTRATOR:BRUCE, SHANNONFACILITY TYPE:
830
ADDRESS:1400 N. VASCO RD.TELEPHONE:
(925) 292-1948
CITY:LIVERMORESTATE: CAZIP CODE:
94551
CAPACITY:24CENSUS: 60DATE:
06/15/2021
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Marquita GladneyTIME COMPLETED:
01:15 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility staff are not properly supervising infants
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 06/15/2021 Licensing Program Analyst (LPA) Jaylena Miller conducted an unannounced subsequent complaint investigation at the facility. LPA met with Director Marquita Gladney and explained the purpose of today’s inspection. The finding for the above allegation was delivered during the visit.
During the investigation the department conducted a physical plant inspection, reviewed facility records, and conducted interviews. During LPA record review and staff interviews it revealed that an incident occurred on 05/17/2021 where C1 was climbing on the shelves, fell and hurt his lower lip that caused slight bleeding and both teachers that were present in the classroom did not see C1 climb on the shelves or fall until he was crying. Based on LPA observation and interviews which were conducted and record reviews, the preponderance of evidence standard has been met, therefore the above allegation is to be SUBSTSNTIATED. As a result, and per California Code of Regulations, Title 22, Division 12, Chapter 1 Section 101429(a)(1) and a Type A deficiency is being cited.
The director must post this report for thirty days. The director must give each parent of the children in care and future parents of newly enrolled children, for the next one year following today’s date, a copy of this report. Parents are to sign an LIC 9224-Acknowledgment of Receipt of Licensing reports and this form shall be placed in each child’s file. Failure to post report and or provide a copy of this report to parent’s/authorized guardians can result in additional monetary assessments to the facility.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Jaylena Miller
LICENSING EVALUATOR SIGNATURE:

DATE: 06/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/15/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 5 of 8
Control Number 52-CC-20210519140613
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: KIDDIE ACADEMY
FACILITY NUMBER: 013422427
VISIT DATE: 06/15/2021
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
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15
16
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20
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23
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25
26
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29
30
31
32
This report must remain on file for three years. The director was provided a copy of their appeal rights (LIC 9058 12/15) and their signature on this form acknowledges receipt of these rights. Notice of site visit was provided and must be posted for 30 days. Exit interview conducted with director, Marquita Gladney.

Please see LIC 9099-D for deficiency cited
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Jaylena Miller
LICENSING EVALUATOR SIGNATURE:

DATE: 06/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/15/2021
LIC9099 (FAS) - (06/04)
Page: 7 of 8
Control Number 52-CC-20210519140613
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: KIDDIE ACADEMY
FACILITY NUMBER: 013422427
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/15/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/15/2021
Section Cited
CCR
101429(a)(1)
1
2
3
4
5
6
7
Responsibility for Providing Care and Supervision for Infants 101429(a)(1)
Each infant shall be constantly supervised and under direct visual observation and supervision by a staff person at all times. This requirement was not met as evidence by:
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7
Director will create a system in the infant room that while one staff is changing/feeding a child, the other staff will be observing the other children in care to ensure the health and safety of children in care.
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Based on observation, interviews and record review, S2 and S3 did not have direct visual observation of C1 while he was climbing or when he fell and hit his lip which poses an immediate risk to the health and safety to children in care.
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Director will also have infant staff watch Supervising Children in Child Care Centers on our website an provide written summary of video to LPA by 6/16/2021.
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7
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Jaylena Miller
LICENSING EVALUATOR SIGNATURE:

DATE: 06/15/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/15/2021
LIC9099 (FAS) - (06/04)
Page: 6 of 8
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
05/19/2021 and conducted by Evaluator Jaylena Miller
PUBLIC
COMPLAINT CONTROL NUMBER: 52-CC-20210519140613

FACILITY NAME:KIDDIE ACADEMYFACILITY NUMBER:
013422427
ADMINISTRATOR:BRUCE, SHANNONFACILITY TYPE:
830
ADDRESS:1400 N. VASCO RD.TELEPHONE:
(925) 292-1948
CITY:LIVERMORESTATE: CAZIP CODE:
94551
CAPACITY:24CENSUS: 60DATE:
06/15/2021
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Marquita GladneyTIME COMPLETED:
01:15 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility staff restrained infant
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 06/15/2021 Licensing Program Analyst (LPA) Jaylena Miller conducted an unannounced subsequent complaint investigation at the facility. LPA met with Director Marquita Gladney and explained the purpose of today’s inspection. The finding for the above allegation was delivered during the visit.
During the investigation the department conducted a physical plant inspection, reviewed facility records, and conducted interviews. During LPA record review and staff interviews it revealed that an incident occurred on 5/11/2021 C1 was climbing on the shelves and after several attempts to redirect him S2 put C1 in a bumbo seat to keep him from climbing. It was also alleged that C1 was also put in a feeding chair to draw and color. Based on LPA observation and interviews which were conducted and records reviewed, the preponderance of evidence standard has been met, therefore the above allegation is to be SUBSTSNTIATED. As a result, and per California Code of Regulations, Title 22, Division 12, Chapter 1 Section 101223(a)(7) and a Type B deficiency is being cited.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Jaylena Miller
LICENSING EVALUATOR SIGNATURE:

DATE: 06/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/15/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 8
Control Number 52-CC-20210519140613
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: KIDDIE ACADEMY
FACILITY NUMBER: 013422427
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/15/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/15/2021
Section Cited
CCR
101223(a)(7)
1
2
3
4
5
6
7
Personal Rights 101223(a)(7)
Not to be placed in any restraining device. This requirement was not met as evidence by:
1
2
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7
Director will meet with infant staff to ensure they are using infant devices for their intended purpose as well as age appropriate. Director will have staff sign in and email sign in sheet to LPA by 7/14/2021.
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Based on observation, interviews and record review, S2 placed C1 in a bumbo seat as a redirection from climbing on the shelves which poses a potential risk to the health and safety of children 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.
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Jaylena Miller
LICENSING EVALUATOR SIGNATURE:

DATE: 06/15/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/15/2021
LIC9099 (FAS) - (06/04)
Page: 3 of 8
Control Number 52-CC-20210519140613
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: KIDDIE ACADEMY
FACILITY NUMBER: 013422427
VISIT DATE: 06/15/2021
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
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25
26
27
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29
30
31
32
Appeal rights were given and discussed, and This report must be available for public review for 3 years. Notice of Site visit provided at the time of the visit and must be posted for 30 days. Exit interview conducted with Director.
Please See LIC-9099 D for deficiency
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Jaylena Miller
LICENSING EVALUATOR SIGNATURE:

DATE: 06/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/15/2021
LIC9099 (FAS) - (06/04)
Page: 4 of 8