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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
073408864
Report Date:
08/09/2024
Date Signed:
08/09/2024 12:41:28 PM
Document Has Been Signed on
08/09/2024 12:41 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 ACADEMY
FACILITY NUMBER:
073408864
ADMINISTRATOR:
NOELLE MILLS
FACILITY TYPE:
850
ADDRESS:
1620 NEROLY RD.
TELEPHONE:
(925) 261-6717
CITY:
OAKLEY
STATE:
CA
ZIP CODE:
94561
CAPACITY:
114
CENSUS:
51
DATE:
08/09/2024
TYPE OF VISIT:
Case Management - Incident
UNANNOUNCED
TIME BEGAN:
12:00 PM
MET WITH:
Ayisha Lopes
TIME COMPLETED:
01:00 PM
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Licensing Program Analyst (LPA) Cherie Acosta conducted an unannounced Case Management visit in regards to an incident that was reported by the director.
During the visit LPA conducted interviews.
There are no deficiencies cited today.
Exit interview and report reviewed with Ayisha Lopes.
Notice of Site Visit was provided and must be posted for 30 days.
SUPERVISOR'S NAME:
Sherelle Johnson
TELEPHONE:
(510) 622-2592
LICENSING EVALUATOR NAME:
Cherie Acosta
TELEPHONE:
(510) 622-1623
LICENSING EVALUATOR SIGNATURE:
DATE:
08/09/2024
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
08/09/2024
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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