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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073408866
Report Date: 09/21/2023
Date Signed: 09/21/2023 05:34:00 PM

Document Has Been Signed on 09/21/2023 05:34 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 ACADEMYFACILITY NUMBER:
073408866
ADMINISTRATOR:GRICELDA MITCHELLFACILITY TYPE:
840
ADDRESS:1620 NERLOY RD.TELEPHONE:
(925) 261-6717
CITY:OAKLEYSTATE: CAZIP CODE:
94561
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 13DATE:
09/21/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:Noelle MillsTIME COMPLETED:
05:45 PM
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Licensing Program Analyst (LPA) Cherie Acosta conducted an unannounced Case Management visit in regards to a self reported incident. LPA met with Director Noelle Mills.

During todays visit, LPA conducted interviews. It was self reported that children engaged in an inappropriate activity while in care. Children were under the play structure and the teacher's view was obstructed while children engaged in the inappropriate activity. Teacher was not aware children were engaging in an inappropriate activity. Adequate supervision was not provided to the children at this time.

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.

Facility is cited a repeat violation today. Facility was previously cited on 6/12/23 for a lack of supervision. A civil penalty os $250.00 is assessed today.

Notice of Site Visit was provided and must be posted for 30 days

Exit interview and report reviewed with Noelle Mills.
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Cherie Acosta
LICENSING EVALUATOR SIGNATURE: DATE: 09/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/21/2023
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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Document Has Been Signed on 09/21/2023 05:34 PM - It Cannot Be Edited


Created By: Cherie Acosta On 09/21/2023 at 04:18 PM
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: 073408866

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/21/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/22/2023
Section Cited
CCR
101229(a)

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Responsibility for Providing Care and Supervision. The licensee shall provide care and supervision as necessary to meet the children's needs. This requirement was not met as evidenced by:
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Director shall develop a plan to ensure children have adequate supervision at all times. Director shall submit a copy of this plan to CCL by 9/22/23.
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Children in care did not have adequate supervision and engaged in an inappropriate activity, which poses an immediate risk to the health and safety of children in care.
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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.
SUPERVISOR'S NAME:Sherelle Johnson
LICENSING EVALUATOR NAME:Cherie Acosta
LICENSING EVALUATOR SIGNATURE:
DATE: 09/21/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/21/2023


LIC809 (FAS) - (06/04)
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