073408281-11-5-2020-02-CC-MMEA-BV7AVN-20201108233345

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 073408281
Report Date: 11/05/2020
Date Signed: 11/05/2020 03:28:16 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
08/05/2020 and conducted by Evaluator Paul Peterson

PUBLIC

COMPLAINT CONTROL NUMBER: 02-CC-20200805102354

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: 16	DATE:	11/05/2020
		UNANNOUNCED	TIME BEGAN:	01:15 PM
MET WITH:	Fey Saeteurn		TIME COMPLETED:	01:45 PM

ALLEGATION(S):

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Staff does not have the required qualifications

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Paul Petersen conducted a complaint investigation of the above allegation. LPA met with facility director, Fey Saeteurn. Interviews were conducted and facility records were reviewed.
Based on the investigative findings, although the allegation may have happened or be valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated at this time.

Facility director was provided a copy of the appeal rights. An exit interview was conducted and a copy of the complaint investigation report provided. The report is to remain in the facility records for a period of three years from today's date.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Mayla Mendoza	TELEPHONE: (510) 873-6408
LICENSING EVALUATOR NAME: Paul Peterson	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 11/05/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/05/2020

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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