093622537-7-22-2019-03-CC-ESIA-BEBP9G-20190722110707

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 093622537
Report Date: 07/22/2019
Date Signed: 07/22/2019 11:07:15 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME:	KCE CHAMPIONS LLC @ JOHN ADAMS AT EL DORADO		FACILITY NUMBER:	093622537
ADMINISTRATOR:	HARLAND, CHRISTA		FACILITY TYPE:	840
ADDRESS:	1102 INVESTMENT BLVD		TELEPHONE:	(916) 479-4977
CITY:	EL DORADO HILLS	STATE: CA	ZIP CODE:	95762
CAPACITY:	60	CENSUS: 29	DATE:	07/22/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Shelly Duncan		TIME COMPLETED:	11:25 AM

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	Licensing Program Analysts (LPAs), Elvira Sierra and Marissa Soto met with Area Manager, Shelly Duncan for an Annual/Random Inspection. Purpose of the visit was explained. Present during the visit were Area Manager and 2 staff caring for 29 school age children. One more staff arrived later during the inspection. Facility meets teacher/child ratio today. Facility operates in the John Adams Academy Charter School Campus in the Multi-Purpose Room (Lunch Room). Program hours of operation are Monday-Friday from 6:30 am to 8:00 am and then Monday-Thursday from 2:50 pm to 6:00pm; and Fridays from 11:30 am to 6:00pm. Facility applied for an increase of capacity. The facility is currently licensed for 60 school age children, ages entry to kindergarten to 14 years old. The facility requested an increase for a total capacity of 146 school age children, adding classrooms # 12, # 13, drama classroom and the gym for additional space activities. Facility was inspected indoors and outdoors for Health and Safety hazards. Cubbies are located inside the classrooms and laundry baskets in the lunch room (multipurpose room) for children belongings. Classrooms have age appropriate toys and equipment that are in good repair. There are a total of 3 separate restrooms for boys and girls to allow privacy and for children usage. Restrooms are maintained clean, in good repair and with adequate supplies. Staff use a separate restroom. Per Director there are no Firearms/ weapons in the facility. Disinfectants, cleaning solutions, poisons are stored inaccessible to children Director was advised that storage areas for poisons shall be locked. Medications are in a safe place inaccessible to children in the Director’s Office. Drinking water is readily available both indoors by water fountains and outdoors by iglu container and children use their own water bottle. Facility provides snacks. All staff working in the facility have criminal background clearance on file with Licensing Office. LPAs advised that prior to working or volunteering in a licensed child care facility, all individuals subject to criminal record review shall obtain a clearance or criminal record exemption. The Department shall notify licensee to immediately terminate the employment of, or to remove/bar any person with specified convictions or for other reasons. The licensee shall comply with the notice. Report continued on page 2..

SUPERVISOR'S NAME: Bettina Engelman	TELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Elvira Sierra	TELEPHONE: (916) 216-8826
LICENSING EVALUATOR SIGNATURE:	DATE: 07/22/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2019

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, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME: KCE CHAMPIONS LLC @ JOHN ADAMS AT EL DORADO	FACILITY NUMBER: 093622537
	VISIT DATE: 07/22/2019

NARRATIVE

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Area Manager understand that at least one person trained in CPR and Pediatric First Aid shall be present when children are at the facility or at offsite activities. The name of the child care center Director or fully qualified teacher(s) designated to act in the director's absence shall be reported to the Department within 10 days of a change.

Facility meets all Posting requirements; (License, parents rights, personal rights, menu, Emergency Disaster & Earthquake Preparedness Plan, Child Car Seat Law) were reviewed today. Staff and children files were review and Staff files records contain a health screening report and children files are complete including Emergency contact information and medical assessment. Sign in/out sheets were reviewed. Area Manager was advised that the person who signs the child in/out shall use their full legal signature and shall record the time of day.

In addition LPAs inspected additional classrooms that were requested to use for the increase of capacity classroom # 12, # 13, Drama classroom and the Gym. The classrooms were observed to be clean and safe for the children. The classrooms had age appropriate toys and furniture. The bathroom were observed to be in working condition. The center is operating on a functioning school site and is exempt from indoor square footage, number of toilets and sinks, fencing, playground space and exclusive use of this space, and isolation space. The center has adequate equipment to support a capacity increase for 146 school age children.

Fire clearance was granted for a capacity of 146 children on 07/12/19.

Prior to issuing the license capacity for 146 children the following must be completed:
1) Bookcases on the classrooms need to be bolt and secure to the wall.
2) Pending upon receive Licensing Program Manager Approval.

No deficiencies were cited during this visit. This report was reviewed and a copy was provided to Area Manager.

SUPERVISOR'S NAME: Bettina Engelman	TELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Elvira Sierra	TELEPHONE: (916) 216-8826
LICENSING EVALUATOR SIGNATURE:	DATE: 07/22/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2019

LIC809 (FAS) - (06/04)

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