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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198008923
Report Date: 12/23/2021
Date Signed: 12/23/2021 01:51:28 PM

Document Has Been Signed on 12/23/2021 01:51 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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:KIDDIE ACADEMY CHILD CARE LEARNING CENTERFACILITY NUMBER:
198008923
ADMINISTRATOR:CARMEN MILLNERFACILITY TYPE:
850
ADDRESS:663 E. FOOTHILL BLVD.TELEPHONE:
(909) 621-5112
CITY:CLAREMONTSTATE: CAZIP CODE:
91711
CAPACITY: 118TOTAL ENROLLED CHILDREN: 128CENSUS: 56DATE:
12/23/2021
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Carmen Millner, DirectorTIME COMPLETED:
02:00 PM
NARRATIVE
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Licensing Program Analyst (LPA) Thelma Razo conducted a subsequent unannounced Required - 1 Year inspection. LPA was greeted by Director Carmen Millner. LPA stated the purpose of the visit. The center is licensed to serve children ages 2 to entry to first grade, 6 toddlers in room 3 ages 18 to 36 months.

Today, LPA reviewed children, staff and facility records. Per Director, fire and earthquake drill is being held every month, log was provided.

All individuals present have obtained a criminal record clearance or criminal record exemption. There is at least one person trained in CPR and Pediatric First Aid present during this inspection. The review of Staff records was documented on the LIC 859. Staff present have proof of the AB 1207 Mandated Reporter Training certificate on file and proof against TB, measles, pertussis, and influenza except for one staff who does not have measles vaccination.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/tion-process.



Two deficiencies were cited under Title 22 and is on the next page. A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with Director Millner.
SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Thelma Razo
LICENSING EVALUATOR SIGNATURE: DATE: 12/23/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/23/2021
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 12/23/2021 01:51 PM - It Cannot Be Edited


Created By: Thelma Razo On 12/23/2021 at 01:07 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
, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: KIDDIE ACADEMY CHILD CARE LEARNING CENTER
FACILITY NUMBER: 198008923

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/23/2021

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.7995(a)(1)


This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in 1 out of 8 staff did not have a measles vaccination which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/31/2021
Plan of Correction
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Director is to submit proof of measles vaccination of staff Aguelda Anzaldo by plan of correction date.
Type B
Section Cited
CCR
101429(a)(2)(B)


This requirement is not met as evidenced by: Director has admitted that the facility did not document infant's sleep every 15 minutes although checks were made.
Deficient Practice Statement
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Based on interview and record review, the licensee did not comply with the section cited above on six out of 6 toddlers under 24 months which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/31/2021
Plan of Correction
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Director is to submit by due date a plan of correction to ensure that the facility will be in compliance at all times.
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:Brandi VanOosten
LICENSING EVALUATOR NAME:Thelma Razo
LICENSING EVALUATOR SIGNATURE:
DATE: 12/23/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/23/2021


LIC809 (FAS) - (06/04)
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