313623554-8-13-2021-03-CC-ABLI-C5USZE-20210813141900

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 313623554
Report Date: 08/13/2021
Date Signed: 08/13/2021 02:19:05 PM

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 LINCOLN CAMPUS		FACILITY NUMBER:	313623554
ADMINISTRATOR:	KIRSCH, ANGELA		FACILITY TYPE:	840
ADDRESS:	1797 BELLA BREEZE DRIVE		TELEPHONE:	(916) 889-3922
CITY:	LINCOLN	STATE: CA	ZIP CODE:	95648
CAPACITY:	121	CENSUS: 39	DATE:	08/13/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:45 PM
MET WITH:	Angela Kirsch		TIME COMPLETED:	02:45 PM

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 Analyst (LPA) Amanda Blesi arrived to the campus at 12:45 p.m. for the purpose of a required annual inspection. LPA checked in with the front office. The Champions program was notified and LPA was escorted to the cafeteria where the children were located. At 1:00pm, LPA observed 39 school age children supervised by 2 teachers and the director. Director was in ratio so in order to do the tour, a group of 9 children went with director and LPA to tour the indoor areas. The facility is located in the John Adams School Campus in rooms 212, 214 with use of the cafeteria, Gym and Lecture Hall. All criminal record clearances are associated to the KCE Champions John Adams facility #313621215. LPA toured the indoor activity areas (the lecture hall was in use by those not in the program and not toured today) restrooms, and outdoor play area. Director indicated room 214 is occupied as a school classroom this afternoon and is not used by the Champion program at this time; therefore, room 214 was not inspected today. Medications were stored in the cafeteria and inaccessible to children. Director stated there are no poisons on the premises. Toxic and hazardous items are inaccessible to children. Furniture and equipment are in good condition. Playground equipment and surfaces are free of loose or sharp parts. The areas around or under climbing equipment are cushioned with wood chips to absorb the fall. Toileting facilities are in sanitary and operating condition. The floors appeared clean throughout the facility. Facility provides am and pm snack. Drinking water was readily available to children both indoors and outdoors. There is a functional carbon monoxide detector that is hardwired into the fire alarm system. Report continued on 809-C.

SUPERVISOR'S NAME: Keven Peters	TELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Amanda Blesi	TELEPHONE: (916) 208-3427
LICENSING EVALUATOR SIGNATURE:	DATE: 08/13/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2021

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

FACILITY NAME: KCE CHAMPIONS LLC @ JOHN ADAMS LINCOLN CAMPUS	FACILITY NUMBER: 313623554
	VISIT DATE: 08/13/2021

NARRATIVE

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Two staff and three children's records were reviewed. Each child's file contained an emergency card. At least one staff member present today has current Pediatric CPR and First Aid certification.

Incidental Medical Services (IMS) policy was discussed. 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

LPA discussed Assembly Bill 2370, which will require licensed Child Care facilities to test their water for excessive amounts of lead. Testing will be required beginning January 1st, 2020 to January 1st, 2023 and must be conducted every five years from initial testing.

This facility evaluation report was reviewed and discussed with Angela Kirsch and an exit interview was conducted. A Notice of Site Visit was provided and should remain posted for a period of 30 days for parental review. Director was encouraged to the visit the Department's website at WWW.CDSS.CA.GOV for information regarding child care updates, forms, regulations and legislation pertaining child care centers.

No deficiencies were cited in the areas that were evaluated today.

SUPERVISOR'S NAME: Keven Peters	TELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Amanda Blesi	TELEPHONE: (916) 208-3427
LICENSING EVALUATOR SIGNATURE:	DATE: 08/13/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2021

LIC809 (FAS) - (06/04)

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