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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 013422427
Report Date: 05/26/2023
Date Signed: 05/26/2023 03:29:37 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND SOUTH EAST, 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
05/03/2023 and conducted by Evaluator Simerjit Kaur
PUBLIC
COMPLAINT CONTROL NUMBER: 52-CC-20230503091950
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: 16DATE:
05/26/2023
UNANNOUNCEDTIME BEGAN:
01:10 PM
MET WITH:Antjuanette CarterTIME COMPLETED:
03:50 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Personal Rights: Staff leave day-care child in soiled diaper for extended periods of time
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On May 5, 2023 Licensing Program Analyst (LPA) Simerjit Kaur met with facility director Antjuanette Carter for a complaint investigation. LPA toured infant component classrooms, Butterflies and Caterpillars. Present during the inspection were 16 infant age children, and 4 staff members. LPA conducted interviews and obtained a copy of the roster.

During the course of the investigation, LPA conducted interviews and record review. It has been disclosed that there have been multiple times when staff left day-care child in soiled diaper for extended periods of time. The allegation has been SUBSTANTIATED. Based on interviews, and record reviews, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED.

Deficiencies cited on 9099D. Appeal Rights provided. Exited interview conducted with facility director Antjuanette Carter.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Simerjit Kaur
LICENSING EVALUATOR SIGNATURE:

DATE: 05/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/26/2023
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 4
Control Number 52-CC-20230503091950
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

FACILITY NAME: KIDDIE ACADEMY
FACILITY NUMBER: 013422427
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/26/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/02/2023
Section Cited
CCR
101223(a)(2)
1
2
3
4
5
6
7
Personal Rights: To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs.
1
2
3
4
5
6
7
The director will discuss diapering needs with staff and will submit a written summary by 6/2/23.
8
9
10
11
12
13
14
This requirement was not met as evidenced by:
Based on interviews, staff leave day-care child in soiled diaper for extended periods of time and which poses a potential health and safety risk to children in care.
8
9
10
11
12
13
14
Type B
06/02/2023
Section Cited
CCR
101229(a)
1
2
3
4
5
6
7
Lack of supervision: The licensee shall provide care and supervision as necessary to meet the children's needs.
1
2
3
4
5
6
7
The director will discuss supervison and will submit a written summary by 6/2/23.
8
9
10
11
12
13
14
This requirement was not met as evidenced by:
Based on interviews, children have hit/bit other children in care, which poses an immediate health and safety risk to children in care.
8
9
10
11
12
13
14
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: Jason Jang
LICENSING EVALUATOR NAME: Simerjit Kaur
LICENSING EVALUATOR SIGNATURE:

DATE: 05/26/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/26/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND SOUTH EAST, 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
05/03/2023 and conducted by Evaluator Simerjit Kaur
COMPLAINT CONTROL NUMBER: 52-CC-20230503091950

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: 16DATE:
05/26/2023
UNANNOUNCEDTIME BEGAN:
01:10 PM
MET WITH:Antjuanette CarterTIME COMPLETED:
03:50 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Lack of supervision: Due to a lack of supervision, child was bit/hit by other day care children
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On May 26, 2023 Licensing Program Analyst (LPA) Simerjit Kaur met with facility director Antjuanette Carter for a complaint investigation. LPA toured infant component classrooms, Butterflies and Caterpillars. Present during the inspection were 16 infant age children, and 4 staff members. LPA obtained a copy of the roster.

During the course of the investigation, LPA conducted interviews and record review. Based on staff and parents interviews, It has been disclosed by staff and more than one parent that there have been multiple biting/hitting incidents involving different children being bit. The allegation has been SUBSTANTIATED. Based on evidence gathered, the standard has been met, therefore the above allegation is found to be SUBSTANTIATED.

Deficiencies cited on 9099D. Appeal Rights provided. Exited interview conducted with facility director Antjuanette Carter.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Simerjit Kaur
LICENSING EVALUATOR SIGNATURE:

DATE: 05/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/26/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND SOUTH EAST, 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
05/03/2023 and conducted by Evaluator Simerjit Kaur
COMPLAINT CONTROL NUMBER: 52-CC-20230503091950

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: DATE:
05/26/2023
UNANNOUNCEDTIME BEGAN:
01:10 PM
MET WITH:Antjuanette CarterTIME COMPLETED:
03:50 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Personal Rights: Day-care child sustained diaper rash while in care due to staff not changing timely
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On May 26, 2023, Licensing Program Analyst (LPA) Simerjit Kaur met with facility director Antjuanette Carter for a complaint investigation. LPA toured infant component classrooms, Butterflies and Caterpillars. Present during the inspection were 16 infant age children, and 4 staff members. LPA obtained a copy of the roster.

During the course of the investigation, LPA conducted interviews and record review. It was alleged that the day-care child sustained diaper rash while in care due to staff not changing timely. It could not be determined if any incident occurred. Although the allegations may have happened or are valid, there are not a preponderance of evidence to prove the alleged violation(s) did or did not occur. Therefore, the allegations are UNSUBSTANTIATED.

Deficiencies cited on 9099D. Appeal Rights provided. Exited interview conducted with facility director Antjuanette Carter.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Simerjit Kaur
LICENSING EVALUATOR SIGNATURE:

DATE: 05/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/26/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 4