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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073408281
Report Date: 07/14/2023
Date Signed: 07/14/2023 01:39:25 PM


Document Has Been Signed on 07/14/2023 01:39 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:SUPREME KIDS ACADEMYFACILITY NUMBER:
073408281
ADMINISTRATOR:HIDY MADDOXFACILITY TYPE:
850
ADDRESS:3065 RICHMOND PARKWAYTELEPHONE:
(510) 964-4058
CITY:RICHMONDSTATE: CAZIP CODE:
94806
CAPACITY:48CENSUS: 36DATE:
07/14/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:09 AM
MET WITH:Hidy MaddoxTIME COMPLETED:
01:46 PM
NARRATIVE
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On July 14, 2023 at 9:09am Licensing Program Analyst (LPA) Indira Loza met with Director Hidy Maddox for an unannounced 1-year required visit. Present for the inspection, the were 36 children and 8 fingerprint cleared staff. During today's visit the LPA collected a children's and Personnel roster. The facility was toured for a health and safety check. The hours of operation are 7am - 6pm, Monday - Friday

CLASSROOMS: The preschool operates out of seven classrooms which were inspected. There were play and learning materials available for the children. The floors, furniture, and equipment are age appropriate and in good repair. There is adequate heating/air conditioning, ventilation and lighting. Drinking water is available inside and outside of the center with jugs filled with water from the faucet. There is proper individual storage space for each child. The center has a smoke detector, a carbon monoxide detector, working telephone, and a fully charged 3A10BC fire extinguisher. There is a fully stocked First Aid kit.
FOOD SERVICE AREAS: This facility provides breakfast, lunch, and one snack for the children. LPA observed the eating area to be clean.
OUTDOOR PLAY AREAS: LPA observed an anchored play structure with cushioning to absorb falls. There were plenty of age appropriate activities.
BATHROOMS AND TOILETING AREAS: This facility has a separate bathroom for the children and the staff. The sinks and faucets are in safe and sanitary operating condition. The children can reach the sinks and toilets. There were supplies available to the children. The Director's office is the isolation area.
RECORDS: All individuals subject to criminal record review have a clearance or exemption. There are opening and closing staff with current CPR training certificates. All required documents are posted in a public accessible area.
Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test. LPA verified
******************************Report Continues on LIC 809-C*************************
SUPERVISOR'S NAME: Mayla MendozaTELEPHONE: (510) 292-9724
LICENSING EVALUATOR NAME: Indira LozaTELEPHONE: 510-368-3672
LICENSING EVALUATOR SIGNATURE:
DATE: 07/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/14/2023
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: SUPREME KIDS ACADEMY
FACILITY NUMBER: 073408281
VISIT DATE: 07/14/2023
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that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP. PIN 22-05-CCP Page Four. CCC has not completed testing prior to the deadline. LPA referred Director Maddox to the Department website for lead: Lead Toxicity Prevention and Water Testing Information.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/.

LPA discussed the safe sleep regulations with Director Maddox and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep as an additional resource. LPA also informed Director Maddox of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment

Director was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.



See LIC809-D for two Type B deficiencies issued during today's visit.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the Director Hidy Maddox.
SUPERVISOR'S NAME: Mayla MendozaTELEPHONE: (510) 292-9724
LICENSING EVALUATOR NAME: Indira LozaTELEPHONE: 510-368-3672
LICENSING EVALUATOR SIGNATURE:

DATE: 07/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 07/14/2023 01:39 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612


FACILITY NAME: SUPREME KIDS ACADEMY
FACILITY NUMBER: 073408281

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/14/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1597.16(a)(1)

(a) (1) A licensed child day care center, as defined in Section 1596.76, that is located in a building that was constructed before January 1, 2010, shall have its drinking water tested for lead contamination levels on or after January 1, 2020, but no later than January 1, 2023, and every five years after the date of the initial test.


This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review and interview, the licensee did not comply with the section cited above as the water was not tested properly with a certified water sampler which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/31/2023
Plan of Correction
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Director shall set an appointment for a certified water sampler to conduct the lead testing at the facility, and send an appointment confirmation to the LPA no later than July 31, 2023.
Type B
Section Cited
CCR
101174(a)
Disaster and Mass Casualty Plan: (d) Disaster drills shall be conducted at least every six months.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above as the last recorded fire drill was in 2021 this poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/31/2023
Plan of Correction
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The Director shall conduct a fire drill and email the LPA an updated fire drill log no later than July 31, 2023.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Mayla MendozaTELEPHONE: (510) 292-9724
LICENSING EVALUATOR NAME: Indira LozaTELEPHONE: 510-368-3672
LICENSING EVALUATOR SIGNATURE:
DATE: 07/14/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/14/2023
LIC809 (FAS) - (06/04)
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