334819673-1-24-2022-09-CC-GCAO-CAZ2RP-20220124163751

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 334819673
Report Date: 01/24/2022
Date Signed: 01/24/2022 04:38:04 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME:	KCE CHAMPIONS LLC @ MARK TWAIN ELEMENTARY SCHOOL		FACILITY NUMBER:	334819673
ADMINISTRATOR:	GRACIE CASTILO		FACILITY TYPE:	840
ADDRESS:	19411 KRAMERIA AVE		TELEPHONE:	(951) 640-5943
CITY:	RIVERSIDE	STATE: CA	ZIP CODE:	92508
CAPACITY:	45	CENSUS: 32	DATE:	01/24/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Graciela Castillo		TIME COMPLETED:	04:50 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	A required – 1-year inspection is being conducted as part of a compliance review. Licensing Program Analyst (LPA) Giselle Carbullido toured the school-age center, inside and out. The following was observed: The inspection consisted of reviews of the following domains: Food Service, Reporting Requirements Physical Plant, Care and Supervision Children Records Staff Records Staffing Ratio and Capacity and Personal Rights The inspection found the facility to be in compliance in these domains, except as noted on the LIC809-D. Deficiencies cited this visit. · A review of the staff records and children's records were conducted as part of this evaluation. · The licensee is asked to update the following documents and submit to licensing within 30 days: Only if changes have been made: 1. LIC 500 Personnel Report 2. LIC 610 Emergency & Disaster Plan 3. Parent Handbook/ Program Curriculum/Admission policies and procedures/ fee schedule (only if changes have been made) 4. LIC 309 Administrative Organization 5. LIC 308 Designation of Administrative Responsibility · The following items have been posted and are updated where necessary: - License, Emergency Disaster Plan (LIC610) and Earthquake Preparedness Checklist (LIC9148) - Parent’s Rights Poster (PUB393), Personal Rights (LIC613A); Child Car Seat Law, Menu

SUPERVISOR'S NAME: Gilbert Sena	TELEPHONE: (951) 782-4844
LICENSING EVALUATOR NAME: Giselle Carbullido	TELEPHONE: (951) 970-1904
LICENSING EVALUATOR SIGNATURE:	DATE: 01/24/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2022

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, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: KCE CHAMPIONS LLC @ MARK TWAIN ELEMENTARY SCHOOL	FACILITY NUMBER: 334819673
	VISIT DATE: 01/24/2022

NARRATIVE

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· The facility is operating within the terms of the license Yes
· Facility is clean, safe and sanitary and in good repair.
· Ratios were met during this inspection: Yes
· Appropriate supervision was provided during this inspection: Yes
· Classrooms are equipped with age appropriate furniture and equipment in good condition
· Classrooms are clean and free of hazards
· All materials and surface accessible to children are toxic free
· No weapons stored at the facility
· There are no bodies of water present.
· Medications are stored where inaccessible to children: in lock box in locked cabinet
· Center is equipped to isolate and care for any child who becomes ill during the day. By Director desk
· Hazards are stored where inaccessible to children which include: disinfectants, cleaning solutions and other items that are dangerous to children: Yes
· All floors shall be clean and safe
· Measures are taken to keep the facility free of flies, other insects and rodents: Public school has routine vendor for pest control
· Toxins are locked
· Bathrooms were observed to be safe, sanitary and in operating condition: yes
· Playgrounds are enclosed by appropriate fences and free of hazards: yes
· Outdoor activity areas are supplied with age and size appropriate equipment in good condition
· Food preparation area is clean and free of vermin: Yes
· Food is stored appropriately and protected from contamination: Yes
· All storage containers for solid waste, including moveable bins shall have tight-fitting covers that are kept on, and in good repair
· Uncontaminated drinking water shall be readily available both in/outdoors and is provided by water fountains for both in/outdoors; water bottles
· The areas around or under high climbing equipment, swings, slides, and similar equipment shall be cushioned with material that absorbs a fall: rubber matting

SUPERVISOR'S NAME: Gilbert Sena	TELEPHONE: (951) 782-4844
LICENSING EVALUATOR NAME: Giselle Carbullido	TELEPHONE: (951) 970-1904
LICENSING EVALUATOR SIGNATURE:	DATE: 01/24/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2022

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, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: KCE CHAMPIONS LLC @ MARK TWAIN ELEMENTARY SCHOOL	FACILITY NUMBER: 334819673
	VISIT DATE: 01/24/2022

NARRATIVE

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· Menus shall be posted at least one week in advance in a place visible by the child’s authorized representative, dated and kept on file for 30 days, and made available upon request.
· Sign in/Sign out record was reviewed and meets regulation requirements
· A Staff member is present with current Pediatric CPR/First Aid which expires on 06/2023
· Opening and closing staff member’s CPR/First Aid expires on 06/2023 (J. K.)
· Director completed Health and Safety Training on July 25 2021
· Staff qualifications and files were reviewed – health screening is on file and all staff meet educational requirements and health requirements for performing assigned tasks: No see LIC809D
· Staff received on the job training for house keeping, sanitation and universal health precautions
· Each child’s file is complete: Yes
· Licensee was informed of the Department has inspection authority per Health and Safety Codes
· A review of staff records on 1/24/22 indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.
The Licensee was informed of their reporting requirements and is provided with the Regional Office’s Unusual Incident Reporting email mailbox: UnusualIncidentReportsDO09@dss.ca.gov
· This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226.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 For CCCs: Incidental Medical Services (IMS) policy was discussed
· Facility representative was reminded that all adults 18 and over living or working in the home, 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.

SUPERVISOR'S NAME: Gilbert Sena	TELEPHONE: (951) 782-4844
LICENSING EVALUATOR NAME: Giselle Carbullido	TELEPHONE: (951) 970-1904
LICENSING EVALUATOR SIGNATURE:	DATE: 01/24/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2022

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, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: KCE CHAMPIONS LLC @ MARK TWAIN ELEMENTARY SCHOOL	FACILITY NUMBER: 334819673
	VISIT DATE: 01/24/2022

NARRATIVE

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· LPA discussed the safe sleep regulations with Facility representative and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed facility representative of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.
A notice of site visit was given and must remain posted for 30 days.
Exit interview conducted and report was reviewed with the licensee Facility representative, Graciela Castillo

SUPERVISOR'S NAME: Gilbert Sena	TELEPHONE: (951) 782-4844
LICENSING EVALUATOR NAME: Giselle Carbullido	TELEPHONE: (951) 970-1904
LICENSING EVALUATOR SIGNATURE:	DATE: 01/24/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2022

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, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: KCE CHAMPIONS LLC @ MARK TWAIN ELEMENTARY SCHOOL	FACILITY NUMBER: 334819673
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/24/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101216(g)(1)

Personnel Requirements

(1) Except as specified in (3) below, good physical health shall be verified by a health screening, including a test for tuberculosis, performed by or under the supervision of a physician not more than one year prior to or seven days after employment or licensure. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review the licensee did not comply with the section cited above in 1 out of 3 persons (S2)which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 01/31/2022
	Plan of Correction
1 2 3 4	Facility Director will submit completed LIC503 to the department for S2 by POC due date 1/31/22

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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 Sena	TELEPHONE: (951) 782-4844
LICENSING EVALUATOR NAME: Giselle Carbullido	TELEPHONE: (951) 970-1904
LICENSING EVALUATOR SIGNATURE:	DATE: 01/24/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2022

LIC809 (FAS) - (06/04)

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