073408270-5-15-2019-02-CC-GRED-BC7SD2-20190515134625

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 073408270
Report Date: 05/15/2019
Date Signed: 05/15/2019 01:46:45 PM

COMPREHENSIVE INSPECTION

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:	SUPER KIDZ CLUB		FACILITY NUMBER:	073408270
ADMINISTRATOR:	BURNS, NICOLE		FACILITY TYPE:	830
ADDRESS:	2140 MINERT RD		TELEPHONE:	(925) 698-8556
CITY:	CONCORD	STATE: CA	ZIP CODE:	94518
CAPACITY:	9	CENSUS: 5	DATE:	05/15/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	11:45 AM
MET WITH:	Nicole Burns, Director		TIME COMPLETED:	02:00 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Redmond, arrived at the facility, unannounced, to conduct an Annual/Random, health and safety inspection. The purpose of the inspection is to ensure the facility is in compliance with Title 22, CCR and Health and Safety Code Statutes for Child Care Centers. During the inspection, LPA met with Nicole Burns, Director. During the inspection, LPA made the following observations: Capacity/Staffing: On this date there are five (5) infants in care. There are currently two (2) teachers and the Director present. The facility is in compliance with capacity limitations, child ratios and staffing levels. LPA inspected all areas of the facility accessible to infants. During the inspection the LPA made the following observations: On Limit areas which are accessible to children include: Infant area, Infant play yard. Off Limit areas which are not accessible to children include: All areas outside infant area, including infant play yard. At the entrance to the facility are the required postings: Facility License, Emergency Disaster Plan, Notification of Parent's Rights, Earthquake Preparedness Checklist. If You See Something, Say Something was added on this date. Parents use a daily sign in sheet to sign in their children. Infant area: Furniture and equipment age appropriate and in good repair. Adequate heating, lighting and ventilation. There are separate cribs for each infant. The Director and staff present, indicated that they are aware of Safe Sleep regulations. CONTINUED

SUPERVISOR'S NAME: Antranette Robinson	TELEPHONE: (510) 622-2591
LICENSING EVALUATOR NAME: Geneen Redmond	TELEPHONE: (510) 873-6410
LICENSING EVALUATOR SIGNATURE:	DATE: 05/15/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2019

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, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: SUPER KIDZ CLUB	FACILITY NUMBER: 073408270
	VISIT DATE: 05/15/2019

NARRATIVE

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Infant play yard: Enclosed by fence. In the infant area, tents have been installed, which must be anchored or removed, an Advisory has been given. There are trees which provide a shaded area. Playground is free of debris and other hazards. No pools or other bodies of water present.

Emergency Preparedness/Safety: Smoke detectors are located throughout the facility and inspected and tested by a professional company. Fire extinguishers were also tested. There are multiple fire extinguishers throughout the facility. There is a carbon monoxide detector, which, per Director is connected to the fire extinguisher. First aid supplies available. Emergency Disaster Plan is dated 3/10/16 and is current, per the Director. Fire and earthquake drills were last conducted on 05/01/19 and meet the six (6) month requirement. The facility utilizes a land line telephone for telephone service. The facility is not currently providing *Incidental Medical Services (IMS) however, is aware of IMS requirements. Director and staff are aware of Safe Sleep regulations and appear to be in compliance on this date.

Exit interview conducted. This Facility Evaluation Report discussed with the Licensee and signature obtained below. Notice of site visit was issued and shall be posted remain posted for 30 days. Failure to keep this notice posted for the 30 consecutive days will result in an immediate $100 civil penalty. A copy of this report shall be maintained for 3 years and available for public review upon request.

NO DEFICIENCIES CITED ON THIS DATE.

SUPERVISOR'S NAME: Antranette Robinson	TELEPHONE: (510) 622-2591
LICENSING EVALUATOR NAME: Geneen Redmond	TELEPHONE: (510) 873-6410
LICENSING EVALUATOR SIGNATURE:	DATE: 05/15/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2019

LIC809 (FAS) - (06/04)

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