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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343622379
Report Date: 08/06/2021
Date Signed: 08/06/2021 03:19:21 PM

Document Has Been Signed on 08/06/2021 03:19 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, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME:KIDDY CLUBFACILITY NUMBER:
343622379
ADMINISTRATOR:REID, MARLETTFACILITY TYPE:
850
ADDRESS:7710 STOCKTON BLVDTELEPHONE:
(916) 617-7248
CITY:SACRAMENTOSTATE: CAZIP CODE:
95823
CAPACITY: 58TOTAL ENROLLED CHILDREN: 0CENSUS: 32DATE:
08/06/2021
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Marlett ReidTIME COMPLETED:
03:15 PM
NARRATIVE
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Licensing Program Analyst (LPA) Gagandeep Singh met with the director, Marlett Reid, for an inspection of plan of correction. The purpose of the inspection was explained.

During today’s inspection, LPA reviewed the staff records. LPA observed three staff members do not have record of all required immunization. The director was informed and is aware that a person may not be employed or volunteer at a child care facility unless he or she has been immunized against influenza, pertussis, and measles.

See next page for deficiencies are cited today. The copy of this report is reviewed and provided to the licensee. Notice of site visit is posted and shall remain posted for next 30 days.
SUPERVISORS NAME: Maria Mayorga
LICENSING EVALUATOR NAME: Gagandeep Singh
LICENSING EVALUATOR SIGNATURE: DATE: 08/06/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/06/2021
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 08/06/2021 03:19 PM - It Cannot Be Edited


Created By: Gagandeep Singh On 08/06/2021 at 02:20 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
, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME: KIDDY CLUB
FACILITY NUMBER: 343622379

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/06/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/27/2021
Section Cited
HSC
1596.7995(a)(1)

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Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles. This requirement is not met as evidenced by record review, LPA did not observe the record of immunization of
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Director agreed to obtain and retain the copy of required immunization of all staff on file by August 27, 2021.
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all present staff on file. This poses a potential Health and Safety risk to children in care.
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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:Maria Mayorga
LICENSING EVALUATOR NAME:Gagandeep Singh
LICENSING EVALUATOR SIGNATURE:
DATE: 08/06/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/06/2021


LIC809 (FAS) - (06/04)
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