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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073408865
Report Date: 11/29/2022
Date Signed: 11/29/2022 05:37:50 PM

Document Has Been Signed on 11/29/2022 05:37 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: 0CENSUS: 11DATE:
11/29/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Kim Kotas and Stephanie BeltramTIME COMPLETED:
05:45 PM
NARRATIVE
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Licensing Program Analyst (LPA) Cherie Acosta conducted an unannounced case management inspection. LPA met with Regional Program Quality Manager Kim Kotas and Regional Support Specialist Stephanie Beltram.

LPA arrived at the facility to conduct an investigation on a complaint. During the complaint investigation LPA toured the facility. LPA observed an aide supervising 6 infants of which 5 of the infants were awake. This is a violation of California Code of Regulations, title 22.

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.

Exit interview conducted and report reviewed with Stephanie Beltram
Notice of Site visit was provided and must be posted for 30 day.
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Cherie Acosta
LICENSING EVALUATOR SIGNATURE: DATE: 11/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/29/2022
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 11/29/2022 05:37 PM - It Cannot Be Edited


Created By: Cherie Acosta On 11/29/2022 at 04:53 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: 11/29/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/30/2022
Section Cited
CCR
101416.3(b)

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Infant Care Aide Qualifications and Duties.An infant care aide shall work under the direct supervision of the director, the assistant director or a fully qualified teacher, except as provided for in Section 101416.5(d)(1)
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Facility shall develop a written plan of action to ensure children and aides are always supervised by a qualified teacher. Written plan shall also include a plan to ensure the required ratio is maintained at all time. A copy of this plan shall be submitted to CCL by 11/30/22.
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This requirement was not met as evidenced by: an aide was supervising 6 infants of which 5 of the infants were awake. A teacher was not supervising the aide.which is 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.
SUPERVISOR'S NAME:Sherelle Johnson
LICENSING EVALUATOR NAME:Cherie Acosta
LICENSING EVALUATOR SIGNATURE:
DATE: 11/29/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/29/2022


LIC809 (FAS) - (06/04)
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