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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073408270
Report Date: 07/14/2022
Date Signed: 07/14/2022 01:46:24 PM


Document Has Been Signed on 07/14/2022 01:46 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, SUITE 1102
OAKLAND, CA 94612



FACILITY NAME:SUPER KIDZ CLUBFACILITY NUMBER:
073408270
ADMINISTRATOR:BURNS, NICOLEFACILITY TYPE:
830
ADDRESS:2140 MINERT RDTELEPHONE:
(925) 698-8556
CITY:CONCORDSTATE: CAZIP CODE:
94518
CAPACITY:9CENSUS: 7DATE:
07/14/2022
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Nicole Burns TIME COMPLETED:
11:30 AM
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On 7/14/22 at 10:00 AM Licensing Program Analysts (LPAs) Michelle Sutton and Monica Mathur conducted an unannounced POC inspection at Super Kidz Club. LPAs met with director/licensee Nicole Burns and explained the purpose of today's visit. During the time of the inspection there were 2 staff and 7 infants.

On 6/29/22 during the Complaint investigation the facility was cited a Type-A for Infant Care activities due to infants being swaddled regularly during nap time. On 6/29/22 facility was cited at Type-B for Infant Care Center Sleeping Equipment due to infants napping with blankets in the crib. Staff conducted a staff meeting on 6/30/22 for Safe sleep regulations and submitted meeting agenda and staff signatures. Both citation were cleared during today's inspection.

Letter of Deficiency Citations Cleared were given to licensee.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the licensee Nicole Burns.


SUPERVISOR'S NAME: Sherelle JohnsonTELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Michelle SuttonTELEPHONE: (510) 725-7004
LICENSING EVALUATOR SIGNATURE:
DATE: 07/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/14/2022
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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