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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364844736
Report Date: 08/18/2023
Date Signed: 08/18/2023 02:22:41 PM


Document Has Been Signed on 08/18/2023 02:22 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
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551



FACILITY NAME:KCE CHAMPIONS LLC @MOUNTAIN VIEW MONTESSORIFACILITY NUMBER:
364844736
ADMINISTRATOR:VEIZER, SIENAFACILITY TYPE:
840
ADDRESS:17000 SILICA DR.,TELEPHONE:
(909) 406-3898
CITY:VICTORVILLESTATE: CAZIP CODE:
92395
CAPACITY:30CENSUS: 0DATE:
08/18/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:27 PM
MET WITH:Perla LomeliTIME COMPLETED:
02:30 PM
NARRATIVE
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On 08/18/2023 Licensing Program Analyst (LPA) Beneroso met with Director Perla Lomeli, for the purpose of conducting an announced annual inspection of the School Age Center. During this inspection, LPA Beneroso toured the facility and observed 49 children present and 2 staff members providing care and supervision. The center is located at the Mountain View Montessori Charter School, Victorville Elementary School District. The center is currently using one classroom. The center operational hours are from Monday through Thursday 6:00am to 8:00am for morning shift. TK program is from 12:30PM to 4:30o and 3:15pm and 5pm for the afternoon shift. Every Friday afternoon from 12:15 PM to 5PM. The center’s license capacity is for 30 children, at the time of visit, there were 49 children present. A Type A Violation was cited for this deficiency.

LPA Beneroso observed age-appropriate furniture, equipment, toys and materials in the classroom. The classroom was observed to be clean, safe and free of any health or safety hazards. Telephone service was verified as well as adequate heating, lighting, and ventilation. LPA observed water fountains outside the classroom. Facility provides disposable cups for drinking water in the classroom, children also use their own water bottles. Medications are not kept in the classroom. There is an area designated for ill/sick children near the main entrance.
SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Barbara BenerosoTELEPHONE: (661) 202-3411
LICENSING EVALUATOR SIGNATURE:
DATE: 08/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/18/2023
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
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: KCE CHAMPIONS LLC @MOUNTAIN VIEW MONTESSORI
FACILITY NUMBER: 364844736
VISIT DATE: 08/18/2023
NARRATIVE
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LPA observed a play structure/apparatus that was securely anchored to the ground. Underneath the play structure LPA observed padding with enough cushion to absorb a fall. LPA observed water fountains in the outdoor play area. The outdoor activity space is located on a functioning public school site.

Furniture and equipment were observed to be in good condition, free of sharp, lose or pointed parts. Cleaning solutions are kept in an upper cabinet. LPA observed the "boys" and "girls" restroom facilities. The bathrooms are separate and located outside the classroom down the hallway. Staff escorts children to and from the restrooms.

This facility serves breakfast, morning snack and afternoon snacks. The facility's snack menu is posted. Fire extinguisher, smoke detectors were observed. There is no carbon monoxide detector in the classroom. A type B Citation was issued for this deficiency.



The Fire/Earthquake drill logs is maintained current and up to date. Last Fire/Earthquake drill was conducted on 06/06/2023. LPA observed required licensing forms; forms were posted on a board near the door. Staff currently have expired Pediatric CPR and First Aid cards. A Type B Citation was issued for this deficiency.

This facility does not currently provide Incidental Medical Services – IMS. Facility does not provide transportation as part of their services. LPA inspected equipment/supplies, and reviewed children’s, personnel, and administrative records. Per director, kids and staff files are not ready (Children started school on 08/15/2023). There were no physical files for staff or children. A Type B citation was issued for this deficiency.
SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Barbara BenerosoTELEPHONE: (661) 202-3411
LICENSING EVALUATOR SIGNATURE:

DATE: 08/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/18/2023
LIC809 (FAS) - (06/04)
Page: 7 of 7
Document Has Been Signed on 08/18/2023 02:22 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551


FACILITY NAME: KCE CHAMPIONS LLC @MOUNTAIN VIEW MONTESSORI
FACILITY NUMBER: 364844736

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/18/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
101516.5(b)(1)
Teacher-Child Ratio
(b) There shall be a staffing ratio of one teacher and one aide present to every 28 children in attendance. (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:
Deficient Practice Statement
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3
4
Based on observation, interview and record review, the licensee did not comply with the section cited above. LPA observed 49 children and two teachers present which poses an immediate health, safety or personal rights risk to persons in care. Facility isc currently licensed for 30 Children.
POC Due Date: 08/18/2023
Plan of Correction
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3
4
During inspection, children were being picked up putting the facility back in ratio.
Section Cited
Deficient Practice Statement
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3
4
POC Due Date:
Plan of Correction
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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: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Barbara BenerosoTELEPHONE: (661) 202-3411
LICENSING EVALUATOR SIGNATURE:
DATE: 08/18/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/18/2023
LIC809 (FAS) - (06/04)
Page: 2 of 7


Document Has Been Signed on 08/18/2023 02:22 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551


FACILITY NAME: KCE CHAMPIONS LLC @MOUNTAIN VIEW MONTESSORI
FACILITY NUMBER: 364844736

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/18/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.954
Licensure Requirements
Every licensed child day care center shall have one or more carbon monoxide detectors in the facility that meet the standards established in Chapter 8 (commencing with Section 13260) of Part 2 of Division 12. The department shall account for the presence of these detectors during inspections.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above in. Per director and per LPA's observations there was no carbon monoxide detector which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/25/2023
Plan of Correction
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Director will submit proof (pictures) of carbon monoxide installed to LPA Beneroso by 08/25/2023.
Type B
Section Cited
CCR
101216(f)
Personnel Requirements
(f) At least one staff member who is trained in pediatric cardiopulmonary resuscitation and pediatric first aid pursuant to Health and Safety Code Section 1596.866 shall be present when children are at the child care center or offsite for center activities.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview and record review, the licensee did not comply with the section cited above. Facility did not have current CPR Cards at the time of the visit which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/25/2023
Plan of Correction
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Director will submit proof (pictures) of CPR Card or proof of registration to LPA Beneroso by 08/25/2023.
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: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Barbara BenerosoTELEPHONE: (661) 202-3411
LICENSING EVALUATOR SIGNATURE:
DATE: 08/18/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/18/2023
LIC809 (FAS) - (06/04)
Page: 3 of 7


Document Has Been Signed on 08/18/2023 02:22 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551


FACILITY NAME: KCE CHAMPIONS LLC @MOUNTAIN VIEW MONTESSORI
FACILITY NUMBER: 364844736

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/18/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101217(d)
Personnel Records
(d) All personnel records shall be maintained at the child care center and shall be available to the licensing agency for review.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and interview the licensee did not comply with the section cited above. Facility did not have files for Children and Staff memebers with the required documentation which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/25/2023
Plan of Correction
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Director will submit proof of staff files and children's files to LPA Beneroso no later than 08/25/2023.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Barbara BenerosoTELEPHONE: (661) 202-3411
LICENSING EVALUATOR SIGNATURE:
DATE: 08/18/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/18/2023
LIC809 (FAS) - (06/04)
Page: 4 of 7


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: KCE CHAMPIONS LLC @MOUNTAIN VIEW MONTESSORI
FACILITY NUMBER: 364844736
VISIT DATE: 08/18/2023
NARRATIVE
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Director was reminded that after March 30, 2018, a person who is a licensed child care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

Director was reminded that any duly authorized officer, employee, or agent of the Department shall, upon presentation of proper identification, shall inspect the facility. Director shall permit the Department to inspect the family child care home, and to privately interview children or staff, to determine compliance with or to prevent violations of child care center or regulations, also enter and inspect any place providing personal care, supervision and services at any time, with or without advance notice, to secure compliance with, or to prevent a violation.

Director advised of the requirement to report Unusual Incidents. Licensee informed to utilize the Unusual Incident Report/Injury Report LIC624B when submitting the report to the department (email address on the website: www.unusualincidentreport@dss.ca.gov). A report shall be made to the department by telephone or fax during the department's normal business hours before the close of the next working day following the occurrence during the operation of the day care center. In addition, a written report shall be submitted to the department within seven days following the occurrence of any events specified above. An On Duty Worker is available for questions at (661) 202-3318 Monday through Friday 8am-5pm.

SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Barbara BenerosoTELEPHONE: (661) 202-3411
LICENSING EVALUATOR SIGNATURE:

DATE: 08/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/18/2023
LIC809 (FAS) - (06/04)
Page: 6 of 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: KCE CHAMPIONS LLC @MOUNTAIN VIEW MONTESSORI
FACILITY NUMBER: 364844736
VISIT DATE: 08/18/2023
NARRATIVE
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During this inspection, One Type A deficiency and 3 Type B deficiencies were issued. A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100. No deficiency was cited today.

Exit interview conducted and report was reviewed with the Director. This report was and provided to along with her appeal rights.

SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Barbara BenerosoTELEPHONE: (661) 202-3411
LICENSING EVALUATOR SIGNATURE:

DATE: 08/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/18/2023
LIC809 (FAS) - (06/04)
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