073408281-6-7-2021-02-CC-LDYN-C44TAC-20210618143316

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 073408281
Report Date: 06/07/2021
Date Signed: 06/07/2021 01:52:41 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
03/22/2021 and conducted by Evaluator Melissa Guirit

PUBLIC

COMPLAINT CONTROL NUMBER: 02-CC-20210322135032

FACILITY NAME:	SUPREME KIDS ACADEMY		FACILITY NUMBER:	073408281
ADMINISTRATOR:	FEY SAETEURN		FACILITY TYPE:	850
ADDRESS:	3065 RICHMOND PARKWAY		TELEPHONE:	(510) 964-4058
CITY:	RICHMOND	STATE: CA	ZIP CODE:	94806
CAPACITY:	48	CENSUS: 23	DATE:	06/07/2021
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Tera Taylor		TIME COMPLETED:	02:20 PM

ALLEGATION(S):

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9

out of ratio

INVESTIGATION FINDINGS:

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On June 7, 2021 at 1:00 PM Licensing Program Analysts (LPAs) Melissa Guirit and Melissa Domantay conducted an unannounced complaint investigation. LPAs met with owner, Tera Taylor. Present for this visit were 23 children and 4 staff members.

It was alleged that the child care center was operating out of ratio. Observations were made and staff records were reviewed. 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 found to be UNSUBSTANTIATED.

There are no deficiencies being cited today. An exit interview was conducted. LPAs discussed and reviewed the report and appeal rights with Licensee. Licensee received a copy of report, notice of site visit and appeal rights. LPA reminded Licensee to have form posted for 30 days. All reports must remain on file for 3 years.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Loretta Dyson	TELEPHONE: (510) 695-0243
LICENSING EVALUATOR NAME: Melissa Guirit	TELEPHONE: (510) 566-8898
LICENSING EVALUATOR SIGNATURE:	DATE: 06/07/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2021

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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