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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073408865
Report Date: 11/04/2022
Date Signed: 11/04/2022 05:20:40 PM

Document Has Been Signed on 11/04/2022 05:20 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 ACADEMYFACILITY NUMBER:
073408865
ADMINISTRATOR:LARONDA LEVIAS-MALLORYFACILITY TYPE:
830
ADDRESS:1620 NERLOY RD.TELEPHONE:
(925) 261-6717
CITY:OAKLEYSTATE: CAZIP CODE:
94561
CAPACITY: 48TOTAL ENROLLED CHILDREN: 18CENSUS: 11DATE:
11/04/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Laronda Levias-MalloryTIME COMPLETED:
05:30 PM
NARRATIVE
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Licensing Program Analyst (LPA) Cherie Acosta conducted an unannounced case management visit. LPA met with Director Laronda Levias-Mallory. There were 11 children in care and 5 staff during the inspection.

During file review for a complaint investigation, LPA observed a documented incident in a staff file. On 10/10/22 C1 was left outside on the play yard without supervision. The facility failed to report the incident to Community Care Licensing and to C1's authorized representative. LPA conducted interviews in regards to the incident. S1 and S2 were supervising the Butterfly classroom on the play yard. When they transitioned into the classroom C1 was left on the play yard unsupervised. S1 and S2 are both teacher aides. There was not a qualified teacher supervising the children at the time of the incident. A staff on the preschool yard noticed C1 was outside and walked her back to her classroom.

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.

A $500.00 civil penalty is assessed today for absence of supervision.
Notice of Site Visit was provided and must be posted for 30 days.
Exit interview and report reviewed with Laronda Levias-Mallory
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Cherie Acosta
LICENSING EVALUATOR SIGNATURE: DATE: 11/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/04/2022
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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Document Has Been Signed on 11/04/2022 05:20 PM - It Cannot Be Edited


Created By: Cherie Acosta On 11/04/2022 at 04:19 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
, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: KIDDIE ACADEMY
FACILITY NUMBER: 073408865

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/04/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/07/2022
Section Cited
CCR
101229(a)(1)

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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.No child(ren) shall be left without the supervision of a teacher at any
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Director shall develop a written plan of action to ensure there are no further incidents. Director shall submit the plan of action to CCL by 11/7/22.
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time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation.This requirement was not met as evidenced by: Children were supervised by aides without a teacher present. C1 was left on play yard unsupervised which poses an immediate risk to the health and safety of children in care

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• This is a zero tolerance violation. An immediate $500 is assessed today and $100 per day will be assessed until corrected. Subsequent zero tolerance violations are $1000 immediate civil penalty and $100 per day will be assessed until corrected.
Type B
11/11/2022
Section Cited
CCR101212(d)

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Reporting Requirements. Upon the occurrence, during the operation of the child care center of any of the events specified in (d)(1) below, a report shall be made to the Department by telephone or fax within the Department's next
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Director shall submit an Unusual Incident Report for this incident to CCL by 11/11/22. Director shall also provide proof to CCL that C1's parent has been informed of the incident. Director shall review the regulation and submit a statement to CCL by 11/11/22 ensuring she understands and shall comply with the regulation.
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working day and during its normal business hours. In addition, a written report containing the information specified in (d)(2) below shall be submitted to the Department within seven days following the occurrence of such event. This requirement was not met as evidenced by: facility did not report incident to CCL which poses 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
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:Sherelle Johnson
LICENSING EVALUATOR NAME:Cherie Acosta
LICENSING EVALUATOR SIGNATURE:
DATE: 11/04/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/04/2022


LIC809 (FAS) - (06/04)
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