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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
073408285
Report Date:
12/08/2022
Date Signed:
12/08/2022 01:32:29 PM
Document Has Been Signed on
12/08/2022 01:32 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, SUITE 1102
OAKLAND
,
CA
94612
FACILITY NAME:
KIDDIE ACADEMY
FACILITY NUMBER:
073408285
ADMINISTRATOR:
AUTUMN BROOKS
FACILITY TYPE:
850
ADDRESS:
8680 BRENTWOOD BLVD.
TELEPHONE:
(925) 683-3369
CITY:
BRENTWOOD
STATE:
CA
ZIP CODE:
94513
CAPACITY:
120
TOTAL ENROLLED CHILDREN:
75
CENSUS:
44
DATE:
12/08/2022
TYPE OF VISIT:
Case Management - Incident
UNANNOUNCED
TIME BEGAN:
12:10 PM
MET WITH:
Autumn Brooks
TIME COMPLETED:
01:45 PM
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Licensing Program Analyst (LPA) Cherie Acosta conducted an unannounced Case Management visit. LPA met with Director Autumn Brooks in regards to a self reported incident. There were 8 staff and 44 children present during the inspection.
During the inspection LPA conducted interviews.
There are no deficiencies cited during today's inspection.
Exit interview and report reviewed with Autumn Brooks.
Notice of Site Visit was provided and must be posted for 30 days.
SUPERVISORS NAME
:
Sherelle Johnson
LICENSING EVALUATOR NAME
:
Cherie Acosta
LICENSING EVALUATOR SIGNATURE
:
DATE:
12/08/2022
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
12/08/2022
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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