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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 073405652
Report Date: 06/29/2022
Date Signed: 06/29/2022 03:26:27 PM

Substantiated


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
06/22/2022 and conducted by Evaluator Monica Mathur
PUBLIC
COMPLAINT CONTROL NUMBER: 02-CC-20220622095429
FACILITY NAME:SUPER KIDZ CLUBFACILITY NUMBER:
073405652
ADMINISTRATOR:BURNS, NICOLEFACILITY TYPE:
850
ADDRESS:2140 MINERT RD.TELEPHONE:
(925) 682-0143
CITY:CONCORDSTATE: CAZIP CODE:
94518
CAPACITY:15CENSUS: 15DATE:
06/29/2022
UNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Nicole BurnsTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Teacher Child Ratio - facility is out of ratio
Outdoor Activity Space - facility playground equipment is in disrepair
INVESTIGATION FINDINGS:
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On 6/29/22 at 9:15 am Licensing Program Analysts (LPAs) Monica Mathur and Michelle Sutton conducted an unannounced Inital 10 day Complaint Investigation at Super Kidz Club. LPAs met with Licensee, Director, Nicole Burns and explained purpose of investigation. Findings for the above allegations was delivered during the inspection.

Complainant alleges that facility is often operating out of ratio. During the course of the investigation, LPA inspected the facility, observations, reviewed records and conducted interviews. It was determined that there have been multiple incidents when facility is often out of ratio with 1 teacher supervising more than 12 children alone. This has been happening due to staff shortage, staff taking their breaks, leaving other staff out of ratio; and during children's diaper changing/bathroom time. However, during the inspection, facility was in ratio. This poses a potential risk to health and safety of children in care, therefore Type B is cited on 9099D.

continued on 9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Monica Mathur
LICENSING EVALUATOR SIGNATURE:

DATE: 06/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 4
Control Number 02-CC-20220622095429
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: SUPER KIDZ CLUB
FACILITY NUMBER: 073405652
VISIT DATE: 06/29/2022
NARRATIVE
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Complainant also alleges that outdoor equipment is in disrepair. LPAs inspected the outdoor play ground and equipment and observed at least 1 plastic play structure is cracked, broken and taped to hold it together. Children were observed playing on them during inspection. .
Based on the interviews and information obtained throughout the investigation, the preponderance of evidence standard has been met. Therefore, the allegations are SUBSTANTIATED. California Code of Regulations, Title 22, Division 12 is being cited on 9099-D page.

Exit interview was conducted with Assistant Director, Marshay Horne.
A NOTICE OF SITE VISIT WAS ISSUED AND MUST BE POSTED FOR 30 DAYS.
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Monica Mathur
LICENSING EVALUATOR SIGNATURE:

DATE: 06/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 02-CC-20220622095429
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

FACILITY NAME: SUPER KIDZ CLUB
FACILITY NUMBER: 073405652
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/29/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/06/2022
Section Cited
CCR
101216.3(a)
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101216.3 Teacher Child Ratio (a) There shall be a ratio of one teacher visually observing and supervising no more than 12 children in attendance [...]. This requirement is not met as evidenced by:
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By POC Due Date 7/6/22 Director agreed to (1) submit a written plan on how facility will operate in compliance moving forward to met teacher child ratios at all times
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Per investigation, it was determined facility is often out of ratio with 1 teacher supervising more than 12 children alone. This happens due to staff shortage, staff taking their breaks, leaving other staff out of ratio; during children's diaper changing/bathroom time. However facility was in ratio during inspection. This poses a potential risk to health and safety of children in care
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(2) hold staff meeting to discuss this regulation and the plan moving forward. Director shall send written confirmation of staff meeting and plan to CCLD no later than 7/6/22
Type B
07/06/2022
Section Cited
CCR
101238.2(d)
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101238.2 Outdoor Activity Space (d) The surface of the outdoor activity space shall be maintained [...]. This requirement is not met as evidenced by:
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By POC Due Date 7/6/22 Director agreed to replace or discard all broken, disrepaired play structures and inspect all equipment for viability and safety in order to stay in compliance with this regulation.
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Per inspection of outdoor play equipment, observed at least 1 plastic play structure is cracked, broken and taped to hold together. Children were observed playing on them during inspection. This poses a potential risk to health, safety of children.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Monica Mathur
LICENSING EVALUATOR SIGNATURE:

DATE: 06/29/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 4