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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 073408865
Report Date: 08/28/2024
Date Signed: 08/28/2024 05:36:26 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/01/2024 and conducted by Evaluator Cherie Acosta
COMPLAINT CONTROL NUMBER: 02-CC-20240701110341
FACILITY NAME:KIDDIE ACADEMYFACILITY NUMBER:
073408865
ADMINISTRATOR:NOELLE MILLSFACILITY TYPE:
830
ADDRESS:1620 NERLOY RD.TELEPHONE:
(925) 261-6717
CITY:OAKLEYSTATE: CAZIP CODE:
94561
CAPACITY:48CENSUS: DATE:
08/28/2024
UNANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:Noelle MillsTIME COMPLETED:
05:45 PM
ALLEGATION(S):
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Staff did not prevent child from being bit.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Cherie Acosta and Joe Mary Vargas conducted an unannounced visit to investigate the above allegation.

During the investigation LPA conducted interviews, toured the classrooms and reviewed incident reports. During the months of June 2024 and July 2024 there were several biting incidents.

Based on LPAs observation and interviews which were conducted and record reviews, the preponderance of evidence standard has been met, therefore the above allegation is to be substantiated.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Cherie Acosta
LICENSING EVALUATOR SIGNATURE:

DATE: 08/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/01/2024 and conducted by Evaluator Cherie Acosta
COMPLAINT CONTROL NUMBER: 02-CC-20240701110341

FACILITY NAME:KIDDIE ACADEMYFACILITY NUMBER:
073408865
ADMINISTRATOR:NOELLE MILLSFACILITY TYPE:
830
ADDRESS:1620 NERLOY RD.TELEPHONE:
(925) 261-6717
CITY:OAKLEYSTATE: CAZIP CODE:
94561
CAPACITY:48CENSUS: DATE:
08/28/2024
UNANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:Noelle MillsTIME COMPLETED:
05:45 PM
ALLEGATION(S):
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Child sustained injury while in care.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Cherie Acosta and Joe Mary Vargas conducted an unannounced visit to investigate the above allegation.

During the investigations LPA conducted interviews, toured the classrooms and reviewed incident reports. Based on the investigation, it is determined that staff did not prevent children from receiving injuries while in care which is a violation of children's personal rights.
Based on LPAs observation and interviews which were conducted and record reviews, the preponderance of evidence standard has been met, therefore the above allegation is to be substantiated.
Notice of Site Visit was provided and must be posted for 30 days.
Exit interview and report reviewed with Noelle Mills.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Cherie Acosta
LICENSING EVALUATOR SIGNATURE:

DATE: 08/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 7
Control Number 02-CC-20240701110341
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		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: 073408865
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/28/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/29/2024
Section Cited
CCR
101223(a)(2)
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Personal Rights.The licensee shall ensure that each child is accorded the following personal rights:to be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs.
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Director shall develop a written plan of action describing how facility will ensure children's safety. Director shall submit a copy of the plan of action to CCL by 8/29/24.
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This requirement was not met as evidenced by: staff did not prevent children from receiving injuries while in care which is a potential risk to the health and safety of children in care.
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Failure to correct will result in a $100 per day civil penalty until corrected. Repeat violations are $250 per violation and $100 per day until corrected.
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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.
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Cherie Acosta
LICENSING EVALUATOR SIGNATURE:

DATE: 08/28/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 7
Control Number 02-CC-20240701110341
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		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: 073408865
VISIT DATE: 08/28/2024
NARRATIVE
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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.

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: 08/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2024
LIC9099 (FAS) - (06/04)
Page: 7 of 7
Control Number 02-CC-20240701110341
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		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: 073408865
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/28/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/29/2024
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: facility failed to provide adequate supervision to prevent incidents which is
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Director shall develop a written plan of action to ensure there is adequate supervision at all times. Director shall submit a copy of the plan of action to CCL by 8/29/24.
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an immediate risk to the health and safety of children in care.
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• Failure to correct will result in a $100 per day civil penalty until corrected. Repeat violations are $250 per violation and $100 per day until corrected.
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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.
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Cherie Acosta
LICENSING EVALUATOR SIGNATURE:

DATE: 08/28/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2024
LIC9099 (FAS) - (06/04)
Page: 6 of 7