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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013422427
Report Date: 07/20/2022
Date Signed: 07/20/2022 03:42:41 PM


Document Has Been Signed on 07/20/2022 03:42 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 STE 1102
OAKLAND, CA 94612



FACILITY NAME:KIDDIE ACADEMYFACILITY NUMBER:
013422427
ADMINISTRATOR:BRUCE, SHANNONFACILITY TYPE:
830
ADDRESS:1400 N. VASCO RD.TELEPHONE:
(925) 292-1948
CITY:LIVERMORESTATE: CAZIP CODE:
94551
CAPACITY:24CENSUS: 13DATE:
07/20/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:20 AM
MET WITH:Ebonee LuceroTIME COMPLETED:
03:50 PM
NARRATIVE
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On 7/20/2022 at approximately 8:30 am, Licensing Program Analyst (LPA) Simerjit Kaur conducted an UNANNOUNCED ANNUAL REQUIRED INSPECTION. LPA met with facility assistant director Ebonee Lucero and the facility was toured to conduct a Health and Safety Inspection. There were 13 infant children and 5 staff members present during the inspection. Hours of operation are Monday through Friday, 7:00am to 6:00pm.

This component operates out of Rooms Caterpillar/infant and Room Butterflies/toddlers. The changing table is within arms reach of the sink. Disinfectants, cleaning solutions, poisons and other items that are dangerous to children were inaccessible during the inspection. The sinks were safe, sanitary and in operable condition. Furniture and equipment are in good condition, and floors are free of tripping hazards. The kitchen/food preparation and storage areas appear to be clean and free of evidence of rodents. All storage containers for solid waste have tight-fitting covers that are in good repair. Drinking water is available both indoors and outdoors. There are no pools or similar bodies of water at this facility. Outdoor activity space and playground equipment observed to be safe and free of hazards. Climbing equipment is properly anchored to the ground with adequate and appropriate cushioning material to absorb falls. There is a shaded area provided for the children. LPA observed working carbon monoxide detector and a fully charged fire extinguisher. Smoke detectors and fire alarms inspections are conducted by Bay Alarm Company.

All required postings are posted. The facility serves breakfast, lunch and AM/PM snacks. The menu is also posted. The food, medication and medical equipment/supplies and is inaccessible to the children. Per director, there are no firearms present on the premises. A copy of the facility personnel roster and children’s roster was obtained.

Continue on LIC 809-C

SUPERVISOR'S NAME: Jason JangTELEPHONE: (510) 622-2631
LICENSING EVALUATOR NAME: Simerjit KaurTELEPHONE: (510) 622-2632
LICENSING EVALUATOR SIGNATURE:
DATE: 07/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/20/2022
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: KIDDIE ACADEMY
FACILITY NUMBER: 013422427
VISIT DATE: 07/20/2022
NARRATIVE
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 LPA reviewed children and staff members files. The opener, Assistant Director and the closer, teacher have current CPR/First Aid certificates that will expire 8/17/2022 and 8/17/2023. The center also conducts, and documents fire and earthquake drills and the logs show that drills were conducted on 4/13/2022. Sign in/out logs are maintained

LPA discussed the Individual Infant Sleep Plan (LIC 9227) and infant/toddler sleep logs. Per assistant director all sleep, feeding and diaper logs are logged via the center app Tadpoles, LPA verified logs via Tadpoles app with assistant director. The assistant director was reminded that baby bouncers, exersaucers, johnny jumpers and similar items are not allowed in licensed day care center.

Assistant Director was reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual – Regulation Interpretations and Procedures for Child Care Center Sections 101173 and 101226. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/(800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm.

Licensee was encouraged to frequently visit our website at www.ccld.ca.gov for licensing regulations and updates. To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.


There are deficiencies cited today. A notice of site visit was given and must remain posted for 30 days. Appeal rights provided. Exit interview conducted and report was reviewed with the facility Assistant Director Ebonee Lucero.
SUPERVISOR'S NAME: Jason JangTELEPHONE: (510) 622-2631
LICENSING EVALUATOR NAME: Simerjit KaurTELEPHONE: (510) 622-2632
LICENSING EVALUATOR SIGNATURE:

DATE: 07/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2022
LIC809 (FAS) - (06/04)
Page: 2 of 6
Document Has Been Signed on 07/20/2022 03:42 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612


FACILITY NAME: KIDDIE ACADEMY
FACILITY NUMBER: 013422427

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/20/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.7995(a)(1)
General Provisions and Definitions
(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.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above which poses a potential health, safety or personal rights risk to persons in care. Facilty staff members did not have proof of immunization records.
POC Due Date: 08/19/2022
Plan of Correction
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Assistant Director will send LPA Kaur a copy of staff members immunization records (MMR, Tdap, & influenza) no later than the due date of 08/19/22.
Type B
Section Cited
CCR
101216(g)(1)
Personnel Requirements
(1) Except as specified in (3) below, good physical health shall be verified by a health screening, including a test for tuberculosis, performed by or under the supervision of a physician not more than one year prior to or seven days after employment or licensure.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above which poses a potential health, safety or personal rights risk to persons in care. 3 Staff members did not have Health Screening Report (LIC 503), 1 staff members did not have a proof of TB Clearance.
POC Due Date: 08/19/2022
Plan of Correction
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Assistant Director will send LPA Kaur a copy of staff members TB clearance, Health Screening Report (LIC 503) no later than the due date of 08/19/22.

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: Jason JangTELEPHONE: (510) 622-2631
LICENSING EVALUATOR NAME: Simerjit KaurTELEPHONE: (510) 622-2632
LICENSING EVALUATOR SIGNATURE:
DATE: 07/20/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/20/2022
LIC809 (FAS) - (06/04)
Page: 3 of 6


Document Has Been Signed on 07/20/2022 03:42 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612


FACILITY NAME: KIDDIE ACADEMY
FACILITY NUMBER: 013422427

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/20/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
101416.3(b)


(b) An infant care aide shall work under the direct supervision of director, assistant director or fully qualified teacher, except as provided for in Section 101416.5(d)(1).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above in which poses/posed a potential health, safety or personal rights risk to persons in care. During the inspection, LPA Kaur observed 5 infants Caterpillar Room, 4 with facility cook/aide and second aide without direct supervision by fully qualified teacher, assistant director or director.
POC Due Date: 08/19/2022
Plan of Correction
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Director/Assistant Director will ensure that all aides are under the direct supervision of a teacher at all times, when caring for infants. Assistant Director will submit a plan to LPA by email, fax, or mail by 8/19/2022, which indicates how she will ensure that aides are always under the direct supervision of a teacher. Assistant Director will have a fully qualified infant care teacher available at all times in each classroom.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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: Jason JangTELEPHONE: (510) 622-2631
LICENSING EVALUATOR NAME: Simerjit KaurTELEPHONE: (510) 622-2632
LICENSING EVALUATOR SIGNATURE:
DATE: 07/20/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/20/2022
LIC809 (FAS) - (06/04)
Page: 5 of 6