<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073408285
Report Date: 01/22/2025
Date Signed: 01/22/2025 10:31:29 AM

Document Has Been Signed on 01/22/2025 10:31 AM - 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 ACADEMYFACILITY NUMBER:
073408285
ADMINISTRATOR/
DIRECTOR:		AUTUMN BROOKSFACILITY TYPE:
850
ADDRESS:8680 BRENTWOOD BLVD.TELEPHONE:
(925) 683-3369
CITY:BRENTWOODSTATE: CAZIP CODE:
94513
CAPACITY: 132TOTAL ENROLLED CHILDREN: 67CENSUS: 49DATE:
01/22/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:20 AM
MET WITH:Michelle PowellTIME VISIT/
INSPECTION COMPLETED:
10:45 AM
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 conducted an unannounced case management visit regarding a self reported incident.

Facility self reported that on 12/24/24, while children were being transitioned from the classroom to the office, a children was left in the classroom bathroom without supervision. The staff and other children had left the classroom and were in the office when it was discovered that a child was not accounted for. Assistant director returned to the classroom and found the child in the bathroom. Facility reports that the child was left alone for approximately 30 seconds.

The attached type A violation is cited today and must be corrected by the due date. Upon receipt, licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. All parents/guardians must sign an acknowledgement form of proof of receiving this report (LIC9224). The LIC 9224 must be placed in the child's file to be reviewed by licensing.

This is a repeat violation. Facility was cited under California Code of Regulations, title 22, section 101229(a)(1) Responsibility for Providing Care and Supervision on 5/15/24. A civil penalty of $250.00 is assessed today for the repeat violation.

Notice of Site Visit was provided and must be posted for 30 days.
Exit interview and report was reviewed with Michelle Powell.
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Cherie Acosta
LICENSING EVALUATOR SIGNATURE: DATE: 01/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/22/2025
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 2
Document Has Been Signed on 01/22/2025 10:31 AM - It Cannot Be Edited


Created By: Cherie Acosta On 01/22/2025 at 08:51 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: KIDDIE ACADEMY
FACILITY NUMBER: 073408285

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/22/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/23/2025
Section Cited
CCR
101229(a)(1)

1
2
3
4
5
6
7
Responsibility for Providing Care and Supervision. The licensee shall provide care and supervision as necessary to meet the children's needs.No child(ren) shall be left without the supervision of a teacher at any
1
2
3
4
5
6
7
Director shall develop a written plan of action to ensure there are no future incidents. Director shall submit a copy of this plan to CCL by 1/23/25. Director shall also provide proof that the parent was informed of the incident.
8
9
10
11
12
13
14
time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation.This requirement was not met as evidenced by: Child was left in the classroom unsupervised which poses an immediate risk to the health and safety of children in care.
8
9
10
11
12
13
14

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Sherelle Johnson
LICENSING EVALUATOR NAME:Cherie Acosta
LICENSING EVALUATOR SIGNATURE:
DATE: 01/22/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/22/2025


LIC809 (FAS) - (06/04)
Page: 2 of 2