<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
073408285
Report Date:
10/17/2024
Date Signed:
10/17/2024 03:42:42 PM
Document Has Been Signed on
10/17/2024 03:42 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:
KIDDIE ACADEMY
FACILITY NUMBER:
073408285
ADMINISTRATOR/
DIRECTOR:
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:
62
CENSUS:
45
DATE:
10/17/2024
TYPE OF VISIT:
Case Management - Other
UNANNOUNCED
TIME VISIT/
INSPECTION BEGAN:
01:45 PM
MET WITH:
Michelle Powell
TIME VISIT/
INSPECTION COMPLETED:
04:00 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Cherie Acosta and Kareeca Sykes conducted an unannounced case management visit. LPAs met with Director Michelle Powell. The purpose of the visit was to amend Complaint Investigation Report (LIC9099-A and LIC9099-D) that was completed on 1/11/24. On 1/11/24 a Type A citation was issued for the facility being out of ratio. This citation is being amended today to a Type B citation.
Also during the inspection LPAs reviewed the director package for Michelle Powell.
Ms. Powell shall provided the following item to CCL by 11/18/24:
- Proof of completion of EMSA approved preventative health and safety training.
- Verification of required 4 years of experience.
- Signed Designation of Facility Responsibility (LIC308)
Report was reviewed with Michelle Powell
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:
10/17/2024
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
10/17/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809
(FAS) - (06/04)
Page:
1
of
1