073408281-1-11-2022-02-CC-DPEZ-CAL3RG-20220111172843

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 073408281
Report Date: 01/11/2022
Date Signed: 01/11/2022 01:56:22 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
10/21/2021 and conducted by Evaluator Catherine Fernandes

PUBLIC

COMPLAINT CONTROL NUMBER: 02-CC-20211021123731

FACILITY NAME:	SUPREME KIDS ACADEMY		FACILITY NUMBER:	073408281
ADMINISTRATOR:	DENISE MORRIS		FACILITY TYPE:	850
ADDRESS:	3065 RICHMOND PARKWAY		TELEPHONE:	(510) 964-4058
CITY:	RICHMOND	STATE: CA	ZIP CODE:	94806
CAPACITY:	48	CENSUS: 30	DATE:	01/11/2022
		UNANNOUNCED	TIME BEGAN:	01:28 PM
MET WITH:	Denise Morris		TIME COMPLETED:	01:59 PM

ALLEGATION(S):

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Staff did not observe child in care was ill.

INVESTIGATION FINDINGS:

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On 1/11/2022 at 1:29PM, Licensing Program Analyst (LPA) Catherine Fernandes arrived to the center to deliver the findings to the above allegation. LPA met with center Director Denise Morris. During the course of the investigation LPA Fernandes conducted interviews, reviewed center documents and observed the center.

There was an incident where a parent picked up her child from the day care and observed her child not feeling well. The parent also reported to her medical provider that her child had a fever during pick up. Staff interviews indicated that they did not observe or recall the child being ill. Therefore the allegation is UNSUBSTANTIATED, 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.

A notice of site visit was given and must remain posted for 30 days.
Exit interview conducted and report provided to Denise Morris

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Mayla Mendoza	TELEPHONE: (510) 873-6408
LICENSING EVALUATOR NAME: Catherine Fernandes	TELEPHONE: (510) 725-7002
LICENSING EVALUATOR SIGNATURE:	DATE: 01/11/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/11/2022

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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