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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334805794
Report Date: 08/06/2024
Date Signed: 08/06/2024 12:19:35 PM


Document Has Been Signed on 08/06/2024 12:19 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
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501



FACILITY NAME:KCE CHAMPIONS LLC @ CASTLE VIEW ELEMENTARY SCHOOLFACILITY NUMBER:
334805794
ADMINISTRATOR:JESSICA MCGINNISFACILITY TYPE:
840
ADDRESS:6201 SHAKER DRIVETELEPHONE:
(951) 786-9025
CITY:RIVERSIDESTATE: CAZIP CODE:
92506
CAPACITY:60CENSUS: 32DATE:
08/06/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Aryanna DyeTIME COMPLETED:
12:30 PM
NARRATIVE
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On 08/06/24 at 12:15PM, a case management visit was completed by Licensing Program Analyst (LPA) Giselle Carbullido due to deficiencies found during the course of another inspection.
1) Children Records:101221(a) A separate, complete, and current record for each child is maintained in the childcare center. During this visit LPA was unable to access a child file as it was not available on site for review. SEE LIC 809D for the deficiency cited.
The Director was provided a copy of their appeal rights and their signature on this form acknowledges receipt of these rights.
An exit interview was conducted, a copy of this report and Notice of Site Visit were provided to the Director, Aryanna Dye. LPA observed the Notice of Site Visit form was posted by staff. THIS REPORT MUST BE AVAILABLE TO THE PUBLIC UPON REQUEST FOR THREE YEARS.
SUPERVISOR'S NAME: Gilbert SenaTELEPHONE: (951) 782-4844
LICENSING EVALUATOR NAME: Giselle CarbullidoTELEPHONE: (951) 970-1904
LICENSING EVALUATOR SIGNATURE:
DATE: 08/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/06/2024
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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Document Has Been Signed on 08/06/2024 12:19 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
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501


FACILITY NAME: KCE CHAMPIONS LLC @ CASTLE VIEW ELEMENTARY SCHOOL

FACILITY NUMBER: 334805794

DEFICIENCY INFORMATION FOR THIS PAGE:

VISIT DATE: 08/06/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/09/2024
Section Cited
CCR
101221(a)

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Child's Records:101221(a) A separate, complete and current record for each child is maintained in the child care center.
This requirement is not met as evidenced by:
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Facility will submit to the department a complete record for the child by POC due date 08/09/24 or earlier.
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Based on interview and record review, the licensee did not comply with the section cited above in that per the Director, a child records were not on site or available for review which poses a potential health, safety or personal rights risk to persons in care.
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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: Gilbert SenaTELEPHONE: (951) 782-4844
LICENSING EVALUATOR NAME: Giselle CarbullidoTELEPHONE: (951) 970-1904
LICENSING EVALUATOR SIGNATURE:
DATE: 08/06/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/06/2024
LIC809 (FAS) - (06/04)
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