<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
073408864
Report Date:
11/07/2023
Date Signed:
11/07/2023 03:28:02 PM
Document Has Been Signed on
11/07/2023 03:28 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:
GRICELDA MITCHELL
FACILITY TYPE:
850
ADDRESS:
1620 NERLOY RD.
TELEPHONE:
(925) 261-6717
CITY:
OAKLEY
STATE:
CA
ZIP CODE:
94561
CAPACITY:
114
TOTAL ENROLLED CHILDREN:
81
CENSUS:
57
DATE:
11/07/2023
TYPE OF VISIT:
Case Management - Incident
UNANNOUNCED
TIME BEGAN:
12:30 PM
MET WITH:
Noelle Mills
TIME COMPLETED:
03:45 PM
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 to follow up on a self reported incident. LPA met with Director Noelle Mills.
It was reported that a child fell during outdoor play and received an injury.
During the visit LPA conducted interviews and toured the facility.
LPA observed the outdoor play structure to be safe. LPA observed appropriate cushioning material under the play structure.
There are no deficiencies cited during today's visit.
Exit interview and report reviewed with Noelle Mills.
SUPERVISORS NAME
:
Sherelle Johnson
LICENSING EVALUATOR NAME
:
Cherie Acosta
LICENSING EVALUATOR SIGNATURE
:
DATE:
11/07/2023
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
11/07/2023
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
1