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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013422427
Report Date: 12/15/2022
Date Signed: 12/15/2022 01:10:16 PM

Document Has Been Signed on 12/15/2022 01:10 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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
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: 24TOTAL ENROLLED CHILDREN: 16CENSUS: 13DATE:
12/15/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Marquita Gladney and Ebonee LuceroTIME COMPLETED:
01:30 PM
NARRATIVE
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On December 15, 2022 at approximately 9:00 AM, Licensing Program Analysts (LPAs) Kelly Phan and LPA Simerjit Kaur met with Center Director Marquita Gladney and Assistant Director, Ebonee Lucero for an unannounced case management and complaint investigation visit. Present today are 13 infants in two classrooms (Caterpillar and Butterfly) with 5 fingerprinted and associated staff members.

During file review and verification on Guardian, it was discovered that there is a staff member who is not fingerprint cleared. LPAs also verified through file review that the staff member has been working at the facility since September 19, 2022 without an eligible clearance and is present during inspection today. Therefore, a Type A citation and a civil penalty will be assessed today. SEE LIC 809D.


LPAs Kelly PHAN and Simerjit Kaur informed facility representatives Marquita Gladney and Ebonee Lucero that this report dated 12/15/2022 document(s) 1 Type A citation(s) which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care.

Also, LPAs informed facility representatives to provide a copy of this licensing report dated 12/15/2022 that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

Exit interview was conducted. Appeal rightts, notice of site visit, and report was reviewed and given to Marquita Gladney and Ebonee Lucero

SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Kelly Phan
LICENSING EVALUATOR SIGNATURE: DATE: 12/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/15/2022
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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Document Has Been Signed on 12/15/2022 01:10 PM - It Cannot Be Edited


Created By: Kelly Phan On 12/15/2022 at 11:24 AM
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
, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: KIDDIE ACADEMY
FACILITY NUMBER: 013422427

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/15/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/15/2022
Section Cited
CCR
101170(e)(1)

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Criminal Record Clearance 101170(e): All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility: (1) Obtain a California clearance or a criminal record exemption as required by the Department. This requirement was not met as evidenced by:
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The facility must obtain an eligible clearance before allowing staff member is allowed to work at the facility

The facility will send an acknowledgement letter stating that the individual is not able to come back or work at the facility until clearance is granted via email by 12/16/2022
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Based record review on Guardian, the facility did not comply with the section cited above as 1 staff member does not have eligible background clearance at the facility, which poses an immediate health, safety or personal rights risk to persons in care.
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Failure to correct will result in a $100 per day civil penalty until corrected. Repeat violations are $250 per violation and $100 per day until corrected.

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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:Jason Jang
LICENSING EVALUATOR NAME:Kelly Phan
LICENSING EVALUATOR SIGNATURE:
DATE: 12/15/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/15/2022


LIC809 (FAS) - (06/04)
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