343614708-9-26-2023-03-CC-EPGO-CW2V2G-20230926160307

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 343614708
Report Date: 09/26/2023
Date Signed: 09/26/2023 04:03:19 PM

Document Has Been Signed on 09/26/2023 04:03 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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME:	KCE CHAMPIONS LLC @ SUNRISE ELEMENTARY		FACILITY NUMBER:	343614708
ADMINISTRATOR:	FULTZ, SANDY		FACILITY TYPE:	840
ADDRESS:	11821 COBBLE BROOK DRIVE		TELEPHONE:	(916) 294-0061
CITY:	RANCHO CORDOVA	STATE: CA	ZIP CODE:	95742
CAPACITY:	90	CENSUS: 15	DATE:	09/26/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:30 PM
MET WITH:			TIME COMPLETED:	02:00 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	Licensing Program Analyst Erwina Pascual-Golamco (LPA) met with Site Director Kaeleigh Wiegman (SD), for an unannounced annual inspection of this school age facility. LPA toured the facility, including all activity and classroom spaces, restrooms, and outdoor play area. The facility is located on Sunrise Elementary School grounds in Portables 1 and 2. The school-age program is in Classroom #1, #3, and #4 from 6:30 AM to 6:00 PM. The facility operates Monday through Friday, and is all year-around. Census included 15 children in care with 2 staff. SD was reminded never to exceed the conditions, limitations and capacity specified on the license. SD was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated. Classrooms observed are clean, including the carpets and floors. Chemicals were kept inaccessible to children. The facility has a Playground Waiver on file for sharing the outdoor playground with Sunrise Elementary following a schedule. Uncontaminated drinking water was readily available to children both indoors and outdoors. The facility provides morning and afternoon snacks for the children. LPA observed a posted menu. continued on LIC809C...

SUPERVISOR'S NAME: Natalie Dunaway	TELEPHONE: (916) 584-3508
LICENSING EVALUATOR NAME: Erwina Pascual-Golamco	TELEPHONE: (916) 206-1524
LICENSING EVALUATOR SIGNATURE:	DATE: 09/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2023

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 @ SUNRISE ELEMENTARY	FACILITY NUMBER: 343614708
	VISIT DATE: 09/26/2023

NARRATIVE

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Bathrooms were sanitary and all sinks and toilets were in operating condition. There are no firearms or bodies of water on the premises and the facility has at least one functioning smoke and carbon monoxide detector. LPA observed all required licensing documentation was posted for parental review. LPA observed that parents are signing their children in and out of the center.

LPA reviewed with SD the LIC311A, Records to Be Maintained at The Facility, for child's records, personnel records, administrative records, and documents to be posted. Children and staff files were reviewed. Each child's file had the required licensing documentation. LPA reviewed staff transcripts and observed all staff caring for children were qualified. At least one staff had a current Pediatric CPR and First Aid certification. Staff all have current Mandated Reporter certificates and proof of immunization. LPA observed a current children's roster and a fire drill log, which was last conducted on 08/28/23. There is First Aid equipment available.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. When any IMS is provided, an updated Plan of Operation that includes 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) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/.

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test. For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1-CCP). LPA verified that the lead testing was completed on 12/02/22 in accordance to the Written Directives outlined in PIN 21-21.1-CCP.
LPA referred SD to the Department website for lead: Lead Toxicity Prevention and Water Testing Information

continued on LIC809C...

SUPERVISOR'S NAME: Natalie Dunaway	TELEPHONE: (916) 584-3508
LICENSING EVALUATOR NAME: Erwina Pascual-Golamco	TELEPHONE: (916) 206-1524
LICENSING EVALUATOR SIGNATURE:	DATE: 09/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2023

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 @ SUNRISE ELEMENTARY	FACILITY NUMBER: 343614708
	VISIT DATE: 09/26/2023

NARRATIVE

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To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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/inspection-process. SD was informed of the https://mychildcareplan.org/; a consumer education website that helps families obtain childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.

No deficiencies were cited during today's inspection. This report was reviewed with SD, and an exit interview was conducted. A Notice of Site Visit (NOS) was provided to SD, who will post it for a period of 30 days for parental review.

SUPERVISOR'S NAME: Natalie Dunaway	TELEPHONE: (916) 584-3508
LICENSING EVALUATOR NAME: Erwina Pascual-Golamco	TELEPHONE: (916) 206-1524
LICENSING EVALUATOR SIGNATURE:	DATE: 09/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2023

LIC809 (FAS) - (06/04)

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