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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343612109
Report Date: 01/10/2020
Date Signed: 01/10/2020 10:13:04 AM

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:CHAMPIONS @ CARROLL ELEMENTARYFACILITY NUMBER:
343612109
ADMINISTRATOR:KINYATA KIDDFACILITY TYPE:
840
ADDRESS:10325 STATHOS DRIVETELEPHONE:
(916) 714-2452
CITY:ELK GROVESTATE: CAZIP CODE:
95757
CAPACITY:50CENSUS: 11DATE:
01/10/2020
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
08:40 AM
MET WITH:Director-Kinyata KiddTIME COMPLETED:
10:30 AM
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Licensing Program Analyst (LPA) Fabiola Diaz met with Director Kinyata Kidd for the purpose of an unannounced case management inspection to follow up on an Unusual Incident Report (UIR) submitted to Community Care Licensing on 1/9/2020. During today’s inspection the facility was toured. Present were 2 staff and 11 children.

The facility reported the UIR to Community Care Licensing within 24 hours. A written UIR was submitted within 7 days, describing the specifics of the incident. The report stated that on 1/8/2020 during outside time a child fell off the monkey bars. One staff member witnessed the incident, but there was three other staff present. The child was taken to the classroom to apply ice, and was picked up by the parent.

During today’s inspection LPA conducted interviews with staff, reviewed the child’s file, and inspected the area of the incident. Director stated that there were 4 teachers supervising 40 children outside during the incident, and teachers were in their designated spots Director stated that staff has had group discussions with the children regarding playground safety everyday since the incident. Director explained that there has also been a staff meeting, to reiterate to staff that there should always be a teacher in the areas that are open to the children during outside time. Director stated that this is standard practice, and it is done daily.

An exit interview was conducted with Director. No deficiencies were cited. A Notice of Site Visit was provided and should remain posted for a period of 30 days for parental review and appeal rights were provided. The Director was encouraged to visit the Department's website at WWW.CCLD.CA.GOV for information regarding child care updates, forms, regulations and legislation pertaining to child care centers.

LPA provided the Child Care Advocates Program email address: childcareadvocatesprogram@dss.ca.gov.

SUPERVISOR'S NAME: Jeanne SmithTELEPHONE: (916) 263-2002
LICENSING EVALUATOR NAME: Fabiola DiazTELEPHONE: (916) 206-9352
LICENSING EVALUATOR SIGNATURE:

DATE: 01/10/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2020
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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