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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343611164
Report Date: 10/11/2023
Date Signed: 10/11/2023 09:55:18 AM


Document Has Been Signed on 10/11/2023 09:55 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827



FACILITY NAME:KCE CHAMPIONS LLC @ ARNOLD ADREANI ELEMENTARYFACILITY NUMBER:
343611164
ADMINISTRATOR:ZUNIGA, CYNTHIAFACILITY TYPE:
840
ADDRESS:9927 WILDHAWK WEST DRIVETELEPHONE:
(916) 405-6094
CITY:SACRAMENTOSTATE: CAZIP CODE:
95829
CAPACITY:75CENSUS: 6DATE:
10/11/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Taylor WinterTIME COMPLETED:
10:15 AM
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Licensing Program Analyst (LPA) Christopher Bello arrived at the facility at approximately 8:30am and conducted random annual inspection. LPA met with director Taylor Winter. This facility is located on Arnold Adreani Elementary school grounds in Portable 1.

Director was reminded that all adults 18 and over, 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 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.

LPA toured the facility including all activity/classroom areas, the isolation area, food service area, restrooms and outdoor play areas. LPA reviewed care and supervision of children, staffing ratios, health related services, furniture, equipment, drinking water and food service provisions. The facility uses the elementary school playground. LPA reviewed some staff and children’s files.

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 Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing 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.

Facility is up to date on their Mandated Reporter Training.

REPORT CONTINUES ON NEXT PAGE.
SUPERVISOR'S NAME: Amanda BlesiTELEPHONE: (916) 208-3427
LICENSING EVALUATOR NAME: Christopher BelloTELEPHONE: (916) 862-0844
LICENSING EVALUATOR SIGNATURE:
DATE: 10/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/11/2023
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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: KCE CHAMPIONS LLC @ ARNOLD ADREANI ELEMENTARY
FACILITY NUMBER: 343611164
VISIT DATE: 10/11/2023
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LPA advised licensee to sign up for the quarterly updates provided by the Childcare Advocates Program. LPA provided the link https://www.cdss.ca.gov/inforesources/Community-Care-Licensing/subscribe for the licensee to sign up for the updates.
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.


No Title 22 Deficiencies observed in the areas that were evaluated. LPA reviewed report with the director and provided copies. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Director, Taylor Winter.
SUPERVISOR'S NAME: Amanda BlesiTELEPHONE: (916) 208-3427
LICENSING EVALUATOR NAME: Christopher BelloTELEPHONE: (916) 862-0844
LICENSING EVALUATOR SIGNATURE:

DATE: 10/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2023
LIC809 (FAS) - (06/04)
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