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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 073405652
Report Date: 09/02/2022
Date Signed: 09/02/2022 12:31:33 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
08/10/2022 and conducted by Evaluator Tasha Hackett-Alexander
PUBLIC
COMPLAINT CONTROL NUMBER: 02-CC-20220810114541
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: 20DATE:
09/02/2022
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:NICOLE BURNSTIME COMPLETED:
12:30 PM
ALLEGATION(S):
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LACK OF SUPERVISION- DAY CARE CHILD WAS NOT ADEQUATELY SUPERVISED

LICENSE- FACILITY IS COMINGLING SCHOOL AGE CHILDREN WITH PRESCHOOL AGE CHILDREN
INVESTIGATION FINDINGS:
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LICENSING PROGRAM ANALYST TASHA ALEXANDER MET WITH CENTER DIRECTOR NICOLE BURNS TO DELIVER THE FINDINGS TO THE ABOVE COMPLAINT ALLEGATIONS.

UPON ARRIVAL THERE ARE 20 PRESCHOOL AGE CHILDREN PRESENT ALONG WITH 8 STAFF. THE SCHOOL AGE PROGRAM IS SCHEDULED TO BEGIN AT 3PM TODAY. DURING THIS ANALYST'S LAST VISIT, AN INTERVIEW WAS CONDUCTED WITH THE CENTER DIRECTOR, RECORDS WERE REVEIWED AND A PHYSICAL INSPECTION OF THE FACILITY WAS CONDUCTED.

BASED ON LPAs OBSERVATIONS AND INTERVIEWS WHICH WERE CONDUCTED AND RECORD REVIEWS, THE PREPODERANCE OF EVIDENCE STANDARD HAS BEEN MET, THEREFORE THE AVOVE ALLEGATIONS ARE FOUND TO BE SUBSTANTIATED. CALIFORNIA CODE OF REGULATIONS, TITLE 22, DIVISION 12 & CHAPTER 1, ARE BEING CITED ON THE ATTACHED LIC 9099D

AN EXIT INTERVIEW WAS CONDUCTED AND NOTICE OF CITED VISIT GIVEN AND POSTED (30 DAYS).
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Loretta DysonTELEPHONE: (510) 695-0243
LICENSING EVALUATOR NAME: Tasha Hackett-AlexanderTELEPHONE: (510) 292-9724
LICENSING EVALUATOR SIGNATURE:

DATE: 09/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/02/2022
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 3
Control Number 02-CC-20220810114541
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: 09/02/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/27/2022
Section Cited
CCR
101161(a)
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101161 Limitations on Capacity
(a) A licensee shall not operate a child care center beyond the conditions and limitations specified on the license, including the capacity limitation. Requirement was not met as evidenced by: A REVIEW OF RECORDS REVEALED SCHOOL AGE CHILDREN ARE BEING COMINGLED WITH PRESCHOOL AGE CHILDREN AT THE END OF THE DAY
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DIRECTOR STATES THAT THIS PRACTICE WILL CEASE IMMEDIATELY AND A PLAN, INCLUDING STAFF TRAINING WILL BE SUBMITTED TO COMMUNITY CARE LICENSING BY 9/27/22
Type B
09/27/2022
Section Cited
CCR
101229.(a)
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101229 Responsibility for Providing Care and Supervision
(a) The licensee shall provide care and supervision as necessary to meet the children's needs.
(1) No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation. REQUIREMENT WAS NOT MET AS EVIDENCED BY: INTERVIEWS/RECORDS REVEALED A CHILD WAS BITTEN ON THE ARM AND STAFF HAD NO KNOWLEDGE OF HOW OR WHEN IT HAPPENED IN JUNE 2022
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LICENSEE WILL ENSURE VISUAL SUPERVISION OF CHILDREN AT ALL TIMES. LICENSEE WILL CONDUCT A TRAINING ON CHILD SUPERVISION WITH STAFF WHICH WILL INCLUDE VIDEOS PROVIDED ON CCL WEBSITE. LICENSEE WILL SUBMIT PROOF OF TRAINING, AND A PLAN TO ENSURE BETTER VISUAL SUPERVISION OF CHILDREN IN CARE BY 9/27/22. LICENSEE HAS EXPRESSED INTEREST IN TSP ASSISTANCE.
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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.
SUPERVISOR'S NAME: Loretta DysonTELEPHONE: (510) 695-0243
LICENSING EVALUATOR NAME: Tasha Hackett-AlexanderTELEPHONE: (510) 292-9724
LICENSING EVALUATOR SIGNATURE:

DATE: 09/02/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/02/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 3