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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304370316
Report Date: 08/16/2022
Date Signed: 08/16/2022 01:17:42 PM


Document Has Been Signed on 08/16/2022 01:17 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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868



FACILITY NAME:KELLIE'S ACADEMY FOR KIDS, CHILD DEV. CTR.FACILITY NUMBER:
304370316
ADMINISTRATOR:FERRIA, DANAEFACILITY TYPE:
830
ADDRESS:5702 CLARK DRIVETELEPHONE:
(714) 377-0533
CITY:HUNTINGTON BEACHSTATE: CAZIP CODE:
92649
CAPACITY:28CENSUS: 4DATE:
08/16/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Robert Gillespie, Owner TIME COMPLETED:
12:00 PM
NARRATIVE
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Licensing Program Analyst (LPA) Nguyen Tran conducted an unannounced Case Management visit. LPA met with Owner, Robert Gillespie to discuss the Lead Sampling Testing conducted on 06/21/2002. Owner, Kellie Gillespie was advised on 08/15/22 that the Lead Sample Report was to be posted. LPA confirmed that the Lead Sample Report was posted.

Owner stated the outlet with high levels of lead are inoperable. They have made the faucets/outlets that tested with high levels of Lead inoperable via plastic bag wrapped around the drinking faucet, taped all
around with a sign “DO NOT USE”. LPA observed the identified outlet was made inoperable. The facility will continue to provide Brita's filtered water for the children in care. LPA observed the Brita's filtered container of water in classroom. The children are using other faucets/outlets that do not exceed the level of lead to wash their hands, and the school will use the water from those faucets/outlets to fill in the Brita's filtered container before serving to the children in care.
Owner stated they had have contacted the Ocean View school district to come up with a plan to fix the identified outlet and will re-test after fixing before putting those outlets back into use. Facility will provide document when the outlet is fixed and tested to LPA prior to to put the outlet back in to use.
Based on LPAs observation and record reviews, no deficiencies were observed of the California Code of Regulations, Title 22, Division 12 at the time of the visit.

Exit interview conducted and report was reviewed with the facility representative Robert Gillespie. A notice of site visit was given and must remain posted for 30 days.
Appeal Rights were explained. The Licensee was provided a copy of appeal rights (LIC 9058 01/16) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the Regional Office within 15 business days. First level appeals should be sent to the regional manager to the address listed above.
(End of Report)
SUPERVISOR'S NAME: Rina LopezTELEPHONE: (714) 795-0859
LICENSING EVALUATOR NAME: Nguyen K TranTELEPHONE: (714) 658-6048
LICENSING EVALUATOR SIGNATURE:
DATE: 08/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/16/2022
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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