073405652-5-10-2024-02-CC-THAR-D55VA5-20240510161523

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 073405652
Report Date: 05/10/2024
Date Signed: 05/10/2024 04:18:59 PM

Document Has Been Signed on 05/10/2024 04:18 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
OAKLAND CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME:	SUPER KIDZ CLUB		FACILITY NUMBER:	073405652
ADMINISTRATOR/ DIRECTOR:	BURNS, NICOLE		FACILITY TYPE:	850
ADDRESS:	2140 MINERT RD.		TELEPHONE:	(925) 682-0143
CITY:	CONCORD	STATE: CA	ZIP CODE:	94518
CAPACITY: 15	TOTAL ENROLLED CHILDREN: 15	CENSUS: 25	DATE:	05/10/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	08:15 AM
MET WITH:	CHARNAYE MCCOWAN		TIME VISIT/ INSPECTION COMPLETED:	03:45 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 5/10/2024 at 8:15am Licensing Program Analyst (LPA) Tasha Alexander met with Lead Teacher Charnaye McCowan for an Unannounced Annual/Random Inspection. Per Ms. McCowan, Director Nicole Burns is off today. During the inspection were twenty-five (25) preschool age children and five (5) staff were present. There is one main classroom that has been divided by partitions. This area was toured for a health and safety inspection. The facility operates from 7:00am – 5:00pm, Monday – Friday. The facility also holds a license for infants, Facility #073408270 and school age, Facility #073404859 as well. The facility has ample age appropriate materials in the classrooms that were observed to be clean and in good condition. All toxins, cleaning products, medications and hazardous materials were observed to be in inaccessible areas. There is at least one (1) fully stocked first-aid kit on site. There is a carbon monoxide detector, several smoke detectors and at least 1 fully charged fire extinguisher as well. All sleeping mats are free from defects, properly maintained and stored. All napping equipment is clean and properly stored. All children’s bathrooms are clean and in proper working order. All medications are properly maintained, documented, and stored at the facility. The outside area is clean, free from defects with ample age-appropriate materials for the children. The play structure is anchored into the ground, the right handle on the ladder of the play structure is loose and needs to be tightened to prevent accident or injury. The slides are sturdy and has turf underneath. There is also plenty of shade for the children. LPA did not observe any harmful or unattended bodies of water in or around the facility. The kitchen is clean area, well maintained, and all hazards are in inaccessible areas. All children have access to clean drinking water in and outside of the classrooms. Children bring their lunch from home and the facility provides morning and afternoon snack. All food provided by the facility is properly stored and labeled.

SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Tasha Hackett-Alexander
LICENSING EVALUATOR SIGNATURE:	DATE: 05/10/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2024

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
OAKLAND CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: SUPER KIDZ CLUB	FACILITY NUMBER: 073405652
	VISIT DATE: 05/10/2024

NARRATIVE

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The facility is operating within their licensed capacity and is in ratio in all classrooms per waiver. All staff have obtained a criminal record clearance, or transfer. All required postings are made visible in the entry way of the facility. The fire/disaster drill log is complete with the last drill logged on 12/2023. A physical census of the children was taken and cross referenced with the sign-in and out log. All children have been properly signed in by their parent or authorized representative. LPA obtained a sample of the children’s files, a sample of the staff files, and the facility files. All files were complete.

Lead Teacher was reminded that EMSA approved Pediatric CPR & First Aid training must be completed every two (2) years. Personnel Roster must be properly maintained, and fire/disaster drill must be conducted every six (6) months and documented. Director was reminded that California Law requires all facilities to report unusual incidents or injuries to children in care, to child's parents, and to the Department of Social Services using the Unusual Incident/Injury form (LIC 624). Incidents must be reported within 24 hours by phone, fax, or email. LPA informed Director that all forms can be downloaded at www.ccld.ca.gov. Director was also informed that Mandated Reporter Training ("General" and "Child Care Providers") is required for all staff and is to be renewed every 2 years by visiting www.mandatedreporterca.com.

LPA discussed the safe sleep regulations with Licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed Licensee 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.

SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Tasha Hackett-Alexander
LICENSING EVALUATOR SIGNATURE:	DATE: 05/10/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2024

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
OAKLAND CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: SUPER KIDZ CLUB	FACILITY NUMBER: 073405652
	VISIT DATE: 05/10/2024

NARRATIVE

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This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226.The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm.

Lead Teacher was reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

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

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with Lead Teacher Charnaye McCowan.

SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Tasha Hackett-Alexander
LICENSING EVALUATOR SIGNATURE:	DATE: 05/10/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2024

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 05/10/2024 04:18 PM - It Cannot Be Edited

Created By: Tasha Hackett-Alexander On 05/10/2024 at 02:39 PM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: SUPER KIDZ CLUB	FACILITY NUMBER: 073405652
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/10/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1596.8662(c)

Administration of Child Day Care Licensing

(c) Current proof of completion for each licensed child day care provider or applicant for that license, administrator, and employee of a licensed child day care facility shall be submitted to the department upon inspection of the child day care or upon request by the department. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in [count] out of [total count] [(objects) (persons)] [identifiers] which poses/posed a potential health, safety or personal rights risk to persons in care. This requirement is not met as evidenced by a review of records which revealed there are 3 staff members that do not have the mandated reporter certificate in file
	POC Due Date: 05/24/2024
	Plan of Correction
1 2 3 4	Licensee will have each staff member complete the mandated employer training and submit a copy of the updated certificate to community care licensing by 5/24/24.

Type B

Section Cited

HSC

1596.7995(a)(1)

General Provisions and Definitions

(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in [count] out of [total count] [(objects) (persons)] [identifiers] which poses/posed a potential health, safety or personal rights risk to persons in care. This requirement is not met as evidenced by a review of records which revealed several staff members do not have immunization records in file
	POC Due Date: 05/24/2024
	Plan of Correction
1 2 3 4	Licensee will have each staff member obtain their immunization records and submit a copy to Community Care Licensing by 5/24/24

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 Mendoza

LICENSING EVALUATOR NAME:

Tasha Hackett-Alexander

LICENSING EVALUATOR SIGNATURE:

DATE: 05/10/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2024

LIC809 (FAS) - (06/04)

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