013421977-3-21-2023-52-CC-MMAW-CQ5V59-20230321160735

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013421977
Report Date: 03/21/2023
Date Signed: 03/21/2023 04:07:47 PM

Document Has Been Signed on 03/21/2023 04:07 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 SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME:	KCE CHAMPIONS @ JAMES MADISON ELEMENTARY SCHOOL		FACILITY NUMBER:	013421977
ADMINISTRATOR:	YZABELLE ECHALAS		FACILITY TYPE:	840
ADDRESS:	14751 JUNIPER ST		TELEPHONE:	(510) 246-1607
CITY:	SAN LEANDRO	STATE: CA	ZIP CODE:	94579
CAPACITY:	56	CENSUS: 0	DATE:	03/21/2023
TYPE OF VISIT:	Case Management - Other	UNANNOUNCED	TIME BEGAN:	01:27 PM
MET WITH:	Treniece Fortson		TIME COMPLETED:	04:22 PM

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On 3/21/2022 at 1:27PM, Licensing Program Analysts (LPA) Michael Mathew and Andrew Elliot conducted a Random inspection. LPA conducted the Covid-19 screening questions prior to entering the facility. LPA met with director Treniece Fortson and advised her the purpose of the inspection. LPAs was provided a tour of the facility inside and out. There were 0 children in care and 5 staff at the time of the inspection.

LPA observed staff (S1) present and caring for children at the facility. S1 is not fingerprinted or associated to the facility. Licensee stated S1 has been working at the facility from 9/22. Site director stated that Area manager is aware of S1 fingerprint pending. Site director stated that all appropriate documentation was sent but is not sure where it was sent to, and mention that this was S1 second time doing fingerprints. Site director also stated that Licensing was contacted and notified regarding S1 fingerprint.

Director 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.

LPA Mathew informed Director Treniece Fortson that this report dated 3/21/23 document One Type A citation and should be posted for 30 consecutive days. LPA Mathew informed Director Treniece Fortson to provide a copy of this licensing report dated 3/21/2023 that documents a Type A citation to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

One Type A deficiency was cited during today's inspection. A civil penalty of $500 has been assessed. 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 Director Treniece Fortson

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Michael Mathew	TELEPHONE: 510-292-8297
LICENSING EVALUATOR SIGNATURE:	DATE: 03/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/21/2023

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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: KCE CHAMPIONS @ JAMES MADISON ELEMENTARY SCHOOL	FACILITY NUMBER: 013421977
	VISIT DATE: 03/21/2023

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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/inspection-process.

Licensee was reminded that all adults 18 and over living or working in the home, 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 licensed Family Child Care Home. 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.

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.

LPA Mathew informed licensee Maria De Santiago that this report dated 2/2/23 document One Type A citation and should be posted for 30 consecutive days. LPA Mathew informed the Director Treniece Fortsonto provide a copy of this licensing report dated 3/21/2023 that documents a Type A citation to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

Exit interview conducted and report was reviewed with Director Treniece Fortsonto

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Michael Mathew	TELEPHONE: 510-292-8297
LICENSING EVALUATOR SIGNATURE:	DATE: 03/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/21/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 03/21/2023 04:07 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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: KCE CHAMPIONS @ JAMES MADISON ELEMENTARY SCHOOL	FACILITY NUMBER: 013421977
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/21/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 04/04/2023 Section Cited	1 2 3 4 5 6 7	(d) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility: This requirement is not met as evidenced by:	1 2 3 4 5 6 7	Director agreed that S1 will not be at the facility until S1 is cleared. Licensee will submit a written plan on how to prevent a similar occurrence in the future. Written plan must be submitted by end of day Tuesday 4/4/23
	8 9 10 11 12 13 14	LPA observed staff (S1) present and caring for children at the facility. S1 is not fingerprinted or associated to the facility. Director stated S1 has been working at the facility from 9/22	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: Wynn Norona	TELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Michael Mathew	TELEPHONE: 510-292-8297
LICENSING EVALUATOR SIGNATURE:	DATE: 03/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/21/2023

LIC809 (FAS) - (06/04)

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