073405009-1-10-2024-02-CC-MDOY-CZCV3G-20240110150443

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 073405009
Report Date: 01/10/2024
Date Signed: 01/10/2024 03:05:00 PM

Document Has Been Signed on 01/10/2024 03:05 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
OAKLAND CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME:	KID'S HIDEOUT		FACILITY NUMBER:	073405009
ADMINISTRATOR:	BROWN, BETH		FACILITY TYPE:	840
ADDRESS:	3309 SPRINGHILL ROAD		TELEPHONE:	(925) 283-7808
CITY:	LAFAYETTE	STATE: CA	ZIP CODE:	94549
CAPACITY: 120	TOTAL ENROLLED CHILDREN: 120	CENSUS: 93	DATE:	01/10/2024
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	01:20 PM
MET WITH:	Elizabeth Brown		TIME COMPLETED:	03:45 PM

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On 1/10/24, Licensing Program Analyst (LPA) M. Domantay conducted a case management inspection at this facility. LPA met with Owner/Program Manager, Elizabeth Brown. There were 93 children and 12 staff present during the inspection. An application was received with a request for adding additional rooms, Room 1-14, Room 19-26, Library, and Multipurpose Room to be added to the license. The facility will operate Monday-Friday 7:00am-6:00pm.

A tour of Rooms 1-14, Rooms 19-26, Library, and Multipurpose Room was conducted for a health and safety inspection with Owner/Program Director, Elizabeth Brown. LPA did not observe any hazardous items, defects or dangerous conditions. Classrooms have a fully charged fire extinguisher in each room and centralized combination carbon monoxide/smoke detection system.

Rooms 1-14, Rooms 19-26, Library, and Multipurpose Room will be added to the facility once Licensing Program Manager, Mai Lor completes her final file review. Program operates on the school grounds of Springhill Elementary, which exempts facility's square footage.

A fire clearance, dated 11/17/23, was received from the Contra Costa Fire Protection Department for adding additional rooms, Room 1-14, Room 19-26, Library, and Multipurpose Room for (120) school age, ages 4.7 years to 12 years.

Exit interview conducted and report was reviewed with the Owner/Program Manager Elizabeth Brown.

The following items are required before a license will be issued:

1. Licensing Program Manager (LPM) final file review.

SUPERVISORS NAME: Mai Lor
LICENSING EVALUATOR NAME: Melissa Domantay
LICENSING EVALUATOR SIGNATURE:	DATE: 01/10/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2024

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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