073408270-9-30-2020-02-CC-SJON-BUKLD2-20201020083913

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 073408270
Report Date: 09/30/2020
Date Signed: 09/30/2020 04:10:58 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/03/2020 and conducted by Evaluator Monica Mathur

PUBLIC

COMPLAINT CONTROL NUMBER: 02-CC-20200803144946

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: 0	DATE:	09/30/2020
		UNANNOUNCED	TIME BEGAN:	12:15 PM
MET WITH:	Nicole Burns		TIME COMPLETED:	04:15 PM

ALLEGATION(S):

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Staff left children unsupervised while in care

INVESTIGATION FINDINGS:

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On 09/30/20 at 12:15 PM Licensing Program Analysts (LPAs) Monica Mathur and Jaylena Miller conducted an unannounced Subsequent Complaint Investigation at the Facility. LPA met with Director Nicole Burns and explained the purpose of today’s inspection. The finding for the above allegation was also delivered during the visit.

During the course of the investigation the department completed a physical plant inspection, reviewed facility records, and conducted interviews. Based on the interviews and information obtained throughout the investigation, the allegation is UNSUBSTANTIATED. Absence of supervision happened under School Age Program but there were siblings commingling with other children from other components. The occurance was one incident with one staff and one group of children, not three separate incidents. Citation and civil penalty has been assessed under school age component only. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED. No Deficiencies have been cited for this allegation for this component.. Exit interview conducted with Director Nicole Burns. A NOTICE OF SITE VISIT WAS ISSUED AND MUST BE POSTED ON OR ADJACENT TO THE INTERIOR SIDE OF THE MAIN DOOR INTO THE FACILITY FOR 30 CONSECUTIVE DAYS.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Sherelle Johnson	TELEPHONE: (510) 725-5998
LICENSING EVALUATOR NAME: Monica Mathur	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 09/30/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2020

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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