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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376700353
Report Date: 07/31/2024
Date Signed: 07/31/2024 01:25:18 PM

Document Has Been Signed on 07/31/2024 01:25 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
RIVERSIDE SE CC RO, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME:KIDDIE ACADEMY CHILDCARE LEARNING CENTERFACILITY NUMBER:
376700353
ADMINISTRATOR/
DIRECTOR:		PLANT, LISAFACILITY TYPE:
850
ADDRESS:3766 MISSION AVENUE #110TELEPHONE:
(760) 439-5552
CITY:OCEANSIDESTATE: CAZIP CODE:
92058
CAPACITY: 126TOTAL ENROLLED CHILDREN: 126CENSUS: 71DATE:
07/31/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Facility Representative Evelyn Avila TIME VISIT/
INSPECTION COMPLETED:
01:35 PM
NARRATIVE
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On 0731/2024 at 9:30 am, Licensing Program Analysts (LPA) Kelly Gerth and Sumayya Habeebulla arrived unannounced at the facility and met with Facility Representative Evelyn Avila to conduct a case management visit.

During the tour of the facility, LPA’s requested documentation for Licensee’s immunization. LPAs requested for the proof of immunization and the facility representative was unable to obtain the proof. The proof of immunization was requested during the previous visit on 06/25/2024 and was not received by the department.

Facility is being cited for 1596.7995(a)(1)

An exit interview was conducted with Facility Representative, Evelyn Avila

Appeal Rights were discussed and provided to Facility Representative, Evelyn Avila

A Notice of Site visit was given, Facility Representative, Evelyn Avila was reminded the notice must remain posted for 30 days.

SUPERVISORS NAME: Carlos Martinez
LICENSING EVALUATOR NAME: Kelly Gerth
LICENSING EVALUATOR SIGNATURE: DATE: 07/31/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/31/2024
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 07/31/2024 01:25 PM - It Cannot Be Edited


Created By: Kelly Gerth On 07/31/2024 at 01:14 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
, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: KIDDIE ACADEMY CHILDCARE LEARNING CENTER
FACILITY NUMBER: 376700353

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/31/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/09/2024
Section Cited
HSC
1596.7995(a)(1)

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(1) 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. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.
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By close of business 08/09/2024, Facility Representative agrees to submit proof to CCLD.
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This has not met as evidenced by, facility was unable to provide verification of immunization, which was requested on previous visit 06/25/24.
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CCR

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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:Carlos Martinez
LICENSING EVALUATOR NAME:Kelly Gerth
LICENSING EVALUATOR SIGNATURE:
DATE: 07/31/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/31/2024


LIC809 (FAS) - (06/04)
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