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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 073408285
Report Date: 08/08/2023
Date Signed: 08/08/2023 10:23:40 AM

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, SUITE 1102
OAKLAND, CA 94612
This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/31/2023 and conducted by Evaluator Cherie Acosta
COMPLAINT CONTROL NUMBER: 02-CC-20230731154057
FACILITY NAME:KIDDIE ACADEMYFACILITY NUMBER:
073408285
ADMINISTRATOR:AUTUMN BROOKSFACILITY TYPE:
850
ADDRESS:8680 BRENTWOOD BLVD.TELEPHONE:
(925) 683-3369
CITY:BRENTWOODSTATE: CAZIP CODE:
94513
CAPACITY:120CENSUS: DATE:
08/08/2023
UNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Autumn BrooksTIME COMPLETED:
10:30 AM
ALLEGATION(S):
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Acknowledgement of Receipt of Licensing Reports was not provided to parents for
Type A deficiencies
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Cherie Acosta conducted an unannounced visit to investigate the above allegation.

The facility was cited Type A deficiencies on 8/4/22, 5/5/23 and 6/28/23. During today's visit LPA reviewed 10 children's file. Of the 10 files reviewed, one file had a signed Acknowledgement of Receipt of Licensing Reports(LIC9224) dated 8/22/22.
Director admitted that most families have not been given copies of licensing reports that document Type A deficiencies.
Based on interviews which were conducted and record reviews, the preponderance of evidence standard has been met, therefore the above allegation is to be substantiated.
Notice of Site visit was provided and must be posted for 30 days.
Exit interview and report reviewed with Autumn Brooks
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Cherie Acosta
LICENSING EVALUATOR SIGNATURE:

DATE: 08/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
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Control Number 02-CC-20230731154057
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, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: KIDDIE ACADEMY
FACILITY NUMBER: 073408285
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/08/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/10/2023
Section Cited
HSC
1596.8595(c)
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A licensed child care facility or home shall provide to the parents of each child receiving services in the facility copies of any licensing report that documents any Type A citation that represents an immediate risk to the health, safety, or personal rights of children in care as specified in paragraph (1) of subdivision (a) of Section 1596.893b.
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Director shall provide copies of licensing reports documenting Type A citation to authorized representative's of children in care. Director shall submit a letter to CCL ensuring this is done by 8/10/23.
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This requirement was not met as evidenced by: facility has not provided licensing reports documenting Type A citations to all families which poses a potential risk to the health and safety of children 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.
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Cherie Acosta
LICENSING EVALUATOR SIGNATURE:

DATE: 08/08/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2023
LIC9099 (FAS) - (06/04)
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