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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 093622537
Report Date: 05/30/2023
Date Signed: 05/30/2023 12:43:41 PM


Document Has Been Signed on 05/30/2023 12:43 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
RIVER CITY (SACTO)CC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827



FACILITY NAME:KCE CHAMPIONS LLC @ JOHN ADAMS AT EL DORADOFACILITY NUMBER:
093622537
ADMINISTRATOR:HARLAND, CHRISTAFACILITY TYPE:
840
ADDRESS:1102 INVESTMENT BLVDTELEPHONE:
(916) 479-4977
CITY:EL DORADO HILLSSTATE: CAZIP CODE:
95762
CAPACITY:146CENSUS: 43DATE:
05/30/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Krista EricksonTIME COMPLETED:
01:00 PM
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On May 30th, 2023, Licensing Program Analyst (LPA) Soleil Marx met with Director, Christa Erickson, for an unannounced required annual inspection. LPA observed a census of 43 school age children being supervised by four staff and the Director. Director was reminded never to exceed the conditions, limitations and capacity specified on the license. Hours of operation are Monday-Friday from 6:30AM to 8:00AM and then Monday-Thursday from 3:00PM to 6:00PM; and Fridays from 11:30AM to 6:00PM. In summer, the program runs Monday-Friday, 7:00AM to 5:30PM. All individuals subject to criminal record review have obtained clearance.

Facility operates in the John Adams Academy Charter School Campus in the Multi-Purpose Room/Lunch Room, drama room, and outdoor activity space. LPA inspected all activity and classroom spaces, restrooms, food service, and outdoor play areas. Hazardous items are inaccessible to children. The floors appeared clean throughout the facility. Furniture and equipment are in safe, operable condition. Playground equipment is in good repair and free of loose or sharp parts. LPA observed adequate cushioning in areas underneath climbing equipment and adequate shade provided. Toileting facilities are in safe, sanitary, and operating condition. The food preparation space is free of litter and all food protected against contamination. Menus were posted for AM/PM snack, which is provided by the facility. Children bring their lunch from home. Uncontaminated drinking water is readily available to children both indoors and outdoors. Medications, first aid supplies, and cleaning solutions are stored in cabinet in a central location, inaccessible to children in care. LPA observed a functional carbon monoxide detector within the facility. LPA observed full legal signatures on the sign in and out sheet. LPA observed required postings, children’s roster, and a fire/disaster drill log in which the last drill was conducted on 04/24/23.

LPA reviewed records for all present staff. At least one staff member present today has current Pediatric CPR and First Aid certification expiring 01/2025. All staff currently employed with the facility have: a criminal record clearance, a health screening report, immunization records, current Mandated Reporter Training, and documentation of their educational background, training, and/or experience. A sample of children’s records were reviewed, LPA observed that each child's file contained all the required documents. (1/2)
SUPERVISOR'S NAME: Natalie DunawayTELEPHONE: (916) 584-3508
LICENSING EVALUATOR NAME: Soleil MarxTELEPHONE: (916) 263-5744
LICENSING EVALUATOR SIGNATURE:
DATE: 05/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/30/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVER CITY (SACTO)CC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: KCE CHAMPIONS LLC @ JOHN ADAMS AT EL DORADO
FACILITY NUMBER: 093622537
VISIT DATE: 05/30/2023
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LPA informed Director about Assembly Bill 2370, which will require certain licensed Child Care Facilities to test their water for excessive amounts of lead. Testing will be required beginning January 1, 2023. This facility has tested their water outlets for lead and no exceedances were found.

Incidental Medical Services (IMS) policy was discussed. The facility is currently providing IMS. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department.
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.

Director was reminded that all adults 18 and working in the facility, 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 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 encouraged Director to the visit the Department's website at WWW.CDSS.CA.GOV for information regarding childcare updates, forms, regulations and legislation pertaining childcare centers. LPA also encouraged the Director to sign up for the Child Care Advocates quarterly newsletter.

No deficiencies were observed during today’s inspection.

This report was reviewed with Director, and an exit interview was conducted. A Notice of Site Visit was provided and must remain posted for 30 days. (2/2)

SUPERVISOR'S NAME: Natalie DunawayTELEPHONE: (916) 584-3508
LICENSING EVALUATOR NAME: Soleil MarxTELEPHONE: (916) 263-5744
LICENSING EVALUATOR SIGNATURE:

DATE: 05/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/30/2023
LIC809 (FAS) - (06/04)
Page: 2 of 2