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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 367750005
Report Date: 08/17/2023
Date Signed: 08/17/2023 06:21:49 PM


Document Has Been Signed on 08/17/2023 06:21 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 @ WEST PALMSFACILITY NUMBER:
367750005
ADMINISTRATOR:MURRAY, KEITHFACILITY TYPE:
840
ADDRESS:14375 DEL GADO RDTELEPHONE:
(760) 694-5036
CITY:VICTORVILLESTATE: CAZIP CODE:
92392
CAPACITY:30CENSUS: 29DATE:
08/17/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:35 PM
MET WITH:Facility Representative, Rosa Wheeler TIME COMPLETED:
06:30 PM
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On August 15, 2023 at 1:35 p.m. Licensing Program Analyst (LPA) Zirbes met with the Facility Representative Rosa Wheeler. The purpose of the inspection was to conduct an unannounced required one year inspection. LPA disclosed the purpose of the inspection to the Facility Representative. Present during today’s inspection were 29 school age children, and three teachers. The school age program consists of two rooms located on West Palms Conservatory School. The two rooms utilized for the Center are the project room (B#58) and multi-purpose room (MPR)/cafeteria . The project room B#58 is used as the main room for the after-school program, the MPR may be used when available. The program operates Monday to Friday. Mornings - 6:30 am to 7:40am; Afternoons - Mon. - Thur. 1:55 p.m to 6:30pm and Fridays 12:04 p.m. to 6:30pm. During Summer 6:00 a.m - 6:30 p.m.
Indoor/Children's Area: Child care center is clean, and sanitary and in good repair; all outdoor and indoor passageways, stair ways, incline, ramps, open porches and other areas of potential hazard are kept free of obstruction. Cleaning compounds are stored in the classroom. The cleaning products were stored in a cabinet equipped with a key lock. The Center was free of flies, other insects, or rodents. The classroom was equipped with tables and chairs to meet children’s needs. All play equipment and materials used by children are age-appropriate, children have individual cubbies labelled with their names for storage of personal belongings. Trash cans for solid waste have tight fitting lids. All materials and surfaces are toxic free. No fireplaces were present in the center classrooms. Carbon monoxide detectors and smoke detectors are located in the classrooms. A fire extinguisher was located in the Classroom. The Center had working telephone service on the premises. There is an isolation area for children who become ill while in care. The facility maintains a comfortable temperature at all times. Sign in/out sheets were available and are completed each day. Sign in an out sheets included information for school drop off and pick up. Smoking prohibited on the premises. Staff complete daily inspections for illness. LPA did not observe prohibited child care items at this time. All electrical outlets were inaccessible. Firearms/weapons are not allowed or stored on premises. There are no bodies of water on the premises. The Center has the menu posted. Report Continued on page two
SUPERVISOR'S NAME: Lady KingTELEPHONE: (310) 568-1824
LICENSING EVALUATOR NAME: Kendal ZirbesTELEPHONE: (661) 202-3491
LICENSING EVALUATOR SIGNATURE:
DATE: 08/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/17/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 9


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 @ WEST PALMS
FACILITY NUMBER: 367750005
VISIT DATE: 08/17/2023
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Report continued from page one Physical Plant (continued): Children have access to water while in the classrooms via personal water bottles and a drinking fountain in the classroom. During the inspection, LPA reviewed the contents of the first aid kit. Based on LPAs review, the first aid kit was not complete and was missing adhesive tape, scissors, tweezers, thermometer, antiseptic solution. Furthermore, one packet containing two Asprin was observed. The first aid kit was contained in a unlocked back pack near the door of the classroom. LPA reminded the Center that the first aid kit had to be accessible to staff but inaccessible to the students. During the inspection, LPA observed the children were engaged in activities away from the door and were under constant supervision by the staff members, therefore the Aspirin was a potential risk to the children in care. Two type B citation were issued, refer to LIC 809D
Restrooms: The Center utilizes the boys and girls restrooms on West Palms Conservatory School. The boys restroom was equipped with one urinal and one one toilet stall, and two sinks, the girls restroom, was equipped with two sinks and two toilets. Additional restrooms are available on the campus. At the time of this inspection, the urinal was not working and was blocked off to the children. Restrooms were age appropriate and contained paper towel and soap dispensers. Additional restrooms available for the staff. Food Service: The Center provides two snacks for the children. Families provide additional snacks for the children.
Outdoor: The Center utilizes the playground on West Palms Conservatory School. The play area consist of grass area, blacktop with basketball hoops, and a large play structure placed on cushioning material which was secured to the ground. Zero bodies of water were observed. Drinking water is readily available to the children when outside via a drinking fountain and a jug of water and cups brought out by the staff.
During the inspection teacher child ratios were observed, and found to met the requirements. Care and supervision was evaluated to determine if the basic needs of children are met and appropriate.
Staff/Child Records
LPA reviewed five child records and three staff member records during this inspection. Child files were complete and contained the required documentation. Based on LPA review, all three staff files reviewed completed the mandated reporter training. However, one staff member (S2), only completed the general mandated reporter training and did not complete the Child Care Provider specific mandated reporter training, an advisory notice was issued. In addition, based on interviews and LPA record review, one of three staff files (S1) did not complete the health screening one year prior to or seven days after employment. A type B citation was issued, refer to LIC 809D. A staff member was on site who had current CPR/First Aid. Continued page three
SUPERVISOR'S NAME: Lady KingTELEPHONE: (310) 568-1824
LICENSING EVALUATOR NAME: Kendal ZirbesTELEPHONE: (661) 202-3491
LICENSING EVALUATOR SIGNATURE:

DATE: 08/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2023
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
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: KCE CHAMPIONS LLC @ WEST PALMS
FACILITY NUMBER: 367750005
VISIT DATE: 08/17/2023
NARRATIVE
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Report continued from page two Facility Records: LPA and Facility representative reviewed the LIC 311A Records To Be Maintained At The Facility. Per conversation with Facility Representative the Center did not have its drinking water tested for lead contamination levels between January 1, 2020 and January 1, 2023. A type B citation was issued. Per conversation with the facility staff member, the Administrator on file with the Department is no longer working at this site. LPA advised the Center to submit the required documentation to the Department so the Administrator can be updated.
Health Related Services
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 Child Care Centers Sections 101173 and 101226.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
Postings:
The following were observed posted as required: facility license, Personal Rights (LIC613A), Parent’s Rights Poster (PUB 393), car seat law (PUB 269), emergency disaster plan.
Topics Discussed:
Any duly authorized officer, employee, or agent of the Department shall, upon presentation of proper identification, shall inspect the facility. The Director shall permit the Department to inspect the center, and to privately interview children or staff, to determine compliance with or to prevent violations of laws 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.

Facility representative was advised of the requirement to report Unusual Incidents. Facility representative informed to utilize the Unusual Incident Report/Injury Report LIC624 when submitting the report to the department (email address: 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 center. In addition, a written report shall be submitted to the department within seven days following the occurrence of any events specified above. The On-Duty Worker is available for questions at (661) 202-3318 Monday through Friday 8am-5pm.
Report continued on page five.
SUPERVISOR'S NAME: Lady KingTELEPHONE: (310) 568-1824
LICENSING EVALUATOR NAME: Kendal ZirbesTELEPHONE: (661) 202-3491
LICENSING EVALUATOR SIGNATURE:

DATE: 08/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2023
LIC809 (FAS) - (06/04)
Page: 3 of 9
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 @ WEST PALMS
FACILITY NUMBER: 367750005
VISIT DATE: 08/17/2023
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Report continued from page four

Facility representative 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.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform. To receive important license related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

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 insectionprocess@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.

Based on LPA observations and record review four type B citations and two technical advisory notices were issued in accordance with the California Code of Regulations, Title 22, see LIC809D.

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. Exit interview conducted and report was reviewed with the facility representative Rosa Wheeler.
SUPERVISOR'S NAME: Lady KingTELEPHONE: (310) 568-1824
LICENSING EVALUATOR NAME: Kendal ZirbesTELEPHONE: (661) 202-3491
LICENSING EVALUATOR SIGNATURE:

DATE: 08/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2023
LIC809 (FAS) - (06/04)
Page: 4 of 9
Document Has Been Signed on 08/17/2023 06:21 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 @ WEST PALMS
FACILITY NUMBER: 367750005

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/17/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1597.16(a)(1)
Lead Testing
(1) A licensed child day care center, as defined in Section 1596.76, that is located in a building that was constructed before January 1, 2010, shall have its drinking water tested for lead contamination levels on or after January 1, 2020, but no later than January 1, 2023, and every five years after the date of the initial test.

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 when the Center did not have its drinking water tested for lead contamination levels between January 1, 2020 and January 1, 2023. which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/31/2023
Plan of Correction
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Per facility representative, the required lead testing will be scheduled by 8.31.23. An email will be submitted to the Department verifying the lead testing inspection has been scheduled.
Type B
Section Cited
CCR
101226(d)(1)
Health-Related Services
(1) The licensee shall maintain the following first-aid supplies in a location accessible to staff but inaccessible to children:

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 when the first aid kit was not complete and was missing Adhesive tape, Scissors, Tweezers, Thermometer, Antiseptic solution, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/24/2023
Plan of Correction
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Per facility representative missing items from the kit will be purchased and added to the kit. At least once a year the kit will be reviewed to ensure all required items are available.
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: Lady KingTELEPHONE: (310) 568-1824
LICENSING EVALUATOR NAME: Kendal ZirbesTELEPHONE: (661) 202-3491
LICENSING EVALUATOR SIGNATURE:
DATE: 08/17/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/17/2023
LIC809 (FAS) - (06/04)
Page: 5 of 9


Document Has Been Signed on 08/17/2023 06:21 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 @ WEST PALMS
FACILITY NUMBER: 367750005

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/17/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101216(g)(1)
Personnel Requirements
(1) Except as specified in (3) below, good physical health shall be verified by a health screening, including a test for tuberculosis, performed by or under the supervision of a physician not more than one year prior to or seven days after employment or licensure.

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 when one of three staff files (S1) did not complete the health screening one year prior to or seven days after employment, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/31/2023
Plan of Correction
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Per facility representative, S1 will schedule the health screening. A copy of the health screening will be added to the staff files and a copy will be submitted to the Department. Facility Administrator will review the files twice a year to ensure the files are complete and contain the required information.
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: Lady KingTELEPHONE: (310) 568-1824
LICENSING EVALUATOR NAME: Kendal ZirbesTELEPHONE: (661) 202-3491
LICENSING EVALUATOR SIGNATURE:
DATE: 08/17/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/17/2023
LIC809 (FAS) - (06/04)
Page: 6 of 9


Document Has Been Signed on 08/17/2023 06:21 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 @ WEST PALMS
FACILITY NUMBER: 367750005

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/17/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101226(e)(1)(A)
Health-Related Services
(e) In centers where the licensee chooses to handle medications: (1) All prescription and nonprescription medications shall be centrally stored in accordance with the requirements specified below: (A) Medications shall be kept in a safe place inaccessible to children.

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 when one packet containing two Aspirin was in observed in the First Aid kit. The first aid kit was contained in a unlocked back pack near the door of the classroom on a hook less than four feet high, this poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/18/2023
Plan of Correction
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The aspirin was immediately removed and placed in a secure location. Per facility representative, twice a year the first aid kit will be reviewed to ensure all required supplies are available.
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: Lady KingTELEPHONE: (310) 568-1824
LICENSING EVALUATOR NAME: Kendal ZirbesTELEPHONE: (661) 202-3491
LICENSING EVALUATOR SIGNATURE:
DATE: 08/17/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/17/2023
LIC809 (FAS) - (06/04)
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