334819673-8-23-2022-09-CC-GSEA-CHRQ2V-20220829114742

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 334819673
Report Date: 08/23/2022
Date Signed: 08/23/2022 05:28:02 PM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

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

This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/10/2022 and conducted by Evaluator Giselle Carbullido

PUBLIC

COMPLAINT CONTROL NUMBER: 09-CC-20220810085723

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: 35	DATE:	08/23/2022
		UNANNOUNCED	TIME BEGAN:	04:10 PM
MET WITH:	Deborah Hill, Site Director		TIME COMPLETED:	05:25 PM

ALLEGATION(S):

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Facility is operating out of ratio.

INVESTIGATION FINDINGS:

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On the date and time listed above, Licensing Program Analyst (LPA) Giselle Carbullido arrived at the facility to conduct an investigation regarding the above complaint received on 08/10/2022. A prior visit was conducted on 8/16/22; which LPA conducted interviews and reviewed records. LPA was given access to the facility by the Deborah Hill, Site Director. LPA discussed purpose of visit, took census and toured the facility. LPA met with the Director to further discuss the complaint allegations and deliver findings.
Facility is operating out of ratio. It was alleged, during the facilities summer program, 40 children were observed with only two staff present, and on occasions, parents/guardians were instructed to take children to a secondary site due to number of children being dropped off for care.
On 08/16/22 LPA toured the facility and obtained the following census: 34 children and five staff. LPA interviewed the Director and one staff who was present during the summer program. Staff stated they were not aware of being out of ratio or having to send children to another site. Director acknowledged instructing parents/guardians to take children to a secondary site and the facility operating out of ratio on a few days.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Gilbert Sena	TELEPHONE: (951) 782-4844
LICENSING EVALUATOR NAME: Giselle Carbullido	TELEPHONE: (951) 970-1904
LICENSING EVALUATOR SIGNATURE:	DATE: 08/23/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2022

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 09-CC-20220810085723

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: 08/23/2022

NARRATIVE

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LPA reviewed facility records, including daily children and staff attendance sheets. Upon review of the attendance sheets, the following staff/child ratios were noted: On 07/11/22: Two teachers to 29 children from 1:30 PM to 2:00 PM On 07/12/22: Two teachers to 30 plus children at multiple times during the day (9AM -10:30AM; 4:00PM -4:30PM). On 07/13/22: Two teachers to 38 children from 10:30AM- 11:00AM On 07/14/22: One teacher to 25 children from 8:30AM- 9:00AM ; two teachers to 31 children in care from 9:00AM -9:30AM On 07/19/22: Two teachers to 40 children from 2PM to 2:30pm; two teachers to 37 children from 2:30pm -3pm. On 07/28/22: Two teachers to 35 children from 12pm- 1pm and two teachers for 34 children from 1pm- 2:30pm

Based on interviews conducted and documents reviewed, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED per California Code of Regulations, Title 22, Division 12. See LIC9099D for cited deficiencies.

LPA Carbullido informed Deborah Hill this report documents one Type A citation, which shall be posted for 30 consecutive days, as there was an immediate risk to the health, safety, or personal rights of children in care. LPA Carbullido informed Deborah Hill to provide a copy of this licensing report to parents/guardians of all children currently enrolled by the next business day, or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

An exit interview was conducted, and appeal rights discussed. A copy of this report, Notice of Site Visit, and appeal rights were provided to Deborah Hill. This report must be made available to the public upon request for three years.

SUPERVISOR'S NAME: Gilbert Sena	TELEPHONE: (951) 782-4844
LICENSING EVALUATOR NAME: Giselle Carbullido	TELEPHONE: (951) 970-1904
LICENSING EVALUATOR SIGNATURE:	DATE: 08/23/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2022

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 09-CC-20220810085723

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: 08/23/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 08/24/2022 Section Cited CCR 101516.5	1 2 3 4 5 6 7	101516.5(b)(1) Teacher- Child ratio: (1) A teacher shall supervise no more than 14 children or with an aide a maximum of 28 children. This requirement is not met as evidenced by:	1 2 3 4 5 6 7	Facility will submit staff schedule showing coverage for am and pm shifts of the afterschool program and a letter stating understanding of regulation 101516.5 (b) (1) and how the teacher-child ratio will be met
	8 9 10 11 12 13 14	Based on interviews conducted and records reviewed, in that the facility did not meet the section above and operated out of ratio on several days: 7/11-7/14 2022; 7/19/22 and 7/28/22. This is an immediate health and safety risk to persons in care.	8 9 10 11 12 13 14	Facility will submit proof of completion of LIC 9224 for all children enrolled in school age program.
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	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: 08/23/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2022

LIC9099 (FAS) - (06/04)

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