073408212-8-17-2021-52-CC-MPRE-C5YQTL-20210817122719

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 073408212
Report Date: 08/17/2021
Date Signed: 08/17/2021 12:27:27 PM

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 STE 1102
OAKLAND, CA 94612

FACILITY NAME:	KCE CHAMPIONS @ BELLA VISTA ELEMENTARY		FACILITY NUMBER:	073408212
ADMINISTRATOR:	MARICRIS MEDRANO		FACILITY TYPE:	840
ADDRESS:	1050 TRUMPET VINE LANE		TELEPHONE:	(925) 828-0129
CITY:	SAN RAMON	STATE: CA	ZIP CODE:	94582
CAPACITY:	133	CENSUS: 5	DATE:	08/17/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:40 AM
MET WITH:	Maricris Medrano		TIME COMPLETED:	12:30 PM

NARRATIVE

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On 8/17/2021 at 9:40am Licensing Program Analyst (LPA) Morgan Pringle met with Director Maricris Medrano for an Unannounced Annual Inspection. Two (2) classrooms were toured for a health and safety inspection. There were five (5) school-age children and two (2) teachers present during the inspection. The facility operates from 6:30am – 6:30pm.

The facility has age appropriate materials in both rooms that is observed to be clean and in good condition. The outdoor space is clean and free from hazards and has proper shading for children. All toxins, cleaning products, medications, and hazardous materials were observed to be in inaccessible areas. All sinks and toilets were observed to be clean and in proper working order. The kitchen/food preparation area was observed to be clean. All knives and cleaning products in the kitchen were made inaccessible to children in care.

The facility is operating within its licensed capacity. All proper posting including the menu are made visible to parents and visitors. A physical census of the children and staff was taken and cross referenced with the sign-in and out log. LPA did not observe any bodies of water at the facility.

LPA obtained the facility roster and a sample of the children’s files and the staff files. All teachers’ files were not complete and children’s files were observed to be complete. The fire and disaster drill log was obtained and is complete. The last drill was logged on 3/17/2021.

The following Deficiencies were observed during today’s inspection

· At 11:15am LPA observed that T1, T2, and T3 were missing current Mandated Reporter Training certificates

· At 11:15 LPA observed T1 is missing a Health Screening Report

Cont on 809-C

SUPERVISOR'S NAME: Jason Jang	TELEPHONE: (510) 725-7009
LICENSING EVALUATOR NAME: Morgan Pringle	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 08/17/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2021

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
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: KCE CHAMPIONS @ BELLA VISTA ELEMENTARY	FACILITY NUMBER: 073408212
	VISIT DATE: 08/17/2021

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Director was reminded that ALL staff, that are 18 years of age or older must be fingerprint cleared and associated to this facility prior to being in the presence of children in care or an immediate civil penalty will be assessed from $100 to $3,000 per person, per incident. Director was reminded of the responsibility as a mandated reporter.

All fire/disaster drills must be conducted at least every six (6) months and documented. The Director was reminded that any structural changes to the facility or additions to the childcare facility must be reported to Community Care Licensing.

Director was encouraged to frequently visit our website at www.ccld.ca.gov for licensing regulations and updates.

This report was read and given to the Director for a signature. There are (2) deficiencies being cited today. This report shall remain on file for three (3) years. Appeal Rights were provided and exit interview conducted. A Notice of Site visit was given and must be posted for 30 days.

SUPERVISOR'S NAME: Jason Jang	TELEPHONE: (510) 725-7009
LICENSING EVALUATOR NAME: Morgan Pringle	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 08/17/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2021

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
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: KCE CHAMPIONS @ BELLA VISTA ELEMENTARY	FACILITY NUMBER: 073408212
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/17/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 08/17/2021 Section Cited	1 2 3 4 5 6 7	1596.8662(4)(b) (1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training...and shall complete renewal mandated reporter training every two years...
	8 9 10 11 12 13 14	This requirement was not met as evidenced by: Based on observation of staff files, all files were not complete	8 9 10 11 12 13 14
Type B 08/17/2021 Section Cited	1 2 3 4 5 6 7	101217(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information: (11) A health screening as specified in Section 101216(g).
	8 9 10 11 12 13 14	This requirement was not met as evidenced by: Based on observation of staff files, T1 is missing a Heath Screening Report	8 9 10 11 12 13 14

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: Jason Jang	TELEPHONE: (510) 725-7009
LICENSING EVALUATOR NAME: Morgan Pringle	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 08/17/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2021

LIC809 (FAS) - (06/04)

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