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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073405652
Report Date: 07/14/2022
Date Signed: 07/14/2022 01:45:53 PM

Document Has Been Signed on 07/14/2022 01:45 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:SUPER KIDZ CLUBFACILITY NUMBER:
073405652
ADMINISTRATOR:BURNS, NICOLEFACILITY TYPE:
850
ADDRESS:2140 MINERT RD.TELEPHONE:
(925) 682-0143
CITY:CONCORDSTATE: CAZIP CODE:
94518
CAPACITY: 15TOTAL ENROLLED CHILDREN: 15CENSUS: 23DATE:
07/14/2022
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Nicole BurnsTIME COMPLETED:
11:30 AM
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On 7/14/22 at 10:00 am Licensing Program Analysts Monica Mathur and Michelle Sutton conducted an unannounced Plan of Correction (POC) inspection at Super Kidz Club. LPAs met with Director/Licensee, Nicole Burns and explained the purpose of today's inspection.

On 6/29/22 during a complaint investigation, allegations were substantiated and facility was cited for ratio requirements and broken/disrepair condition of outdoor play equipment.

During today's inspection, facility was in ratio compliance with 3 staff, 21 children in the play ground, and 2 staff, 2 children inside the preschool classroom. Broken equipment has been removed from the play yard. Citations were cleared and Letter of Clearance was provided.

This report was reviewed and discussed with Director/Licensee, Nicole Burns and a NOTICE OF SITE VISIT WAS PROVIDED, TO BE POSTED FOR 30 CONSECUTIVE DAYS.
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Monica Mathur
LICENSING EVALUATOR SIGNATURE: DATE: 07/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/14/2022
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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