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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376701101
Report Date: 08/05/2021
Date Signed: 08/05/2021 01:56:28 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME:KCE CHAMPIONS LLC @ HEARST ELEMENTARYFACILITY NUMBER:
376701101
ADMINISTRATOR:ALMA MEJIAFACILITY TYPE:
840
ADDRESS:6230 DEL CERRO BOULEVARDTELEPHONE:
(916) 387-5761
CITY:SAN DIEGOSTATE: CAZIP CODE:
92120
CAPACITY:168CENSUS: 26DATE:
08/05/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:Alma MejiaTIME COMPLETED:
02:15 PM
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On August 5, 2021 at 9:20 a.m. Licensing Program Analyst (LPA) Leilani Curtis conducted an unannounced annual inspection. In addition to the annual inspection LPA addressed the licensee’s request for a room addition and capacity increase. Upon arrival LPA met with Site Directors Sarah Rehart and Alma Mejia and proceeded to tour the facility. Also present were a total of 26 children in the following classrooms:
  • Library: 6 children with staff member Luis Lebron
  • Cafeteria: 5 children with staff member Debra Pallmann
  • Auditorium: 15 children with staff members Emma Loaiza, Vanessa Sanchez and Jocelyn Delariva.


The licensee has not exceeded the approved capacity of the fire clearance for the facility. Appropriate ratios and capacity were observed. All children are supervised, including visual supervision, of a teacher. Staff members have the required background clearances and are associated to the facility. There are no excluded individuals present. The facility is clean, safe, sanitary, and in good repair to ensure the safety and well-being of children, employees and visitors. Furniture and age appropriate equipment is in good condition indoors and outdoors. The food preparation area is clean. All foods and beverages capable of supporting the rapid and progressive growth of microorganisms that can cause food intoxication's are stored in covered containers at 45 degrees F or less if required. LPA and Director Mejia observed two containers of milk in the facility refrigerator with expiration dates of 7/22/21. Storage containers for solid waste are covered with tight-fitting lids. Drinking water is readily accessible inside and outside the classroom. Restrooms are maintained with operational toilets and faucets with appropriate temperature. The children's toilets and hand washing facilities are sanitary. All disinfectants, cleaning solutions, and other hazardous items are inaccessible to children. Storage area for poisons is locked.
SUPERVISOR'S NAME: Tashima DanielTELEPHONE: (619) 767-2242
LICENSING EVALUATOR NAME: Grace CurtisTELEPHONE: (619) 767-2235
LICENSING EVALUATOR SIGNATURE:

DATE: 08/05/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2021
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 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME: KCE CHAMPIONS LLC @ HEARST ELEMENTARY
FACILITY NUMBER: 376701101
VISIT DATE: 08/05/2021
NARRATIVE
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The outdoor activity space surface is maintained in a safe condition and free of hazards. Playground equipment is safe and free of sharp, loose or pointed parts. The areas around and under high climbing equipment, swings, slides & similar equipment have cushioning to absorb the impact of a fall. The outdoor play area is fenced and there are trees and covered areas for shade. There are no bodies of water or weapons at this facility. Fire drills are being conducted every 6 months. The last documented fire drill occurred on 8/4/2021. There is an operational carbon monoxide detector at the facility that meet statutory requirements. First Aid/CPR certifications were reviewed and are in compliance. Admission Agreement forms reviewed for some children. Emergency information forms and medical assessment forms were reviewed for some children. Staff records contain documentation of education, training, and/or experience. Health screening forms were reviewed for some staff. Sign in/sign out sheets are well maintained. The person who signs the child in/out uses their full legal signature and records the time of day. Menus are posted where an authorized representative can view them.

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.



SUPERVISOR'S NAME: Tashima DanielTELEPHONE: (619) 767-2242
LICENSING EVALUATOR NAME: Grace CurtisTELEPHONE: (619) 767-2235
LICENSING EVALUATOR SIGNATURE:

DATE: 08/05/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2021
LIC809 (FAS) - (06/04)
Page: 2 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME: KCE CHAMPIONS LLC @ HEARST ELEMENTARY
FACILITY NUMBER: 376701101
VISIT DATE: 08/05/2021
NARRATIVE
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The facility is currently licensed to operate in the following rooms: Cafeteria, Auditorium, Art Corp Room, Library, #1, #8, #9, K1, B5, B8 and B9. The licensee has requested to add rooms B3, B4, K2, K3, #2, #3, #5, #7 and #12 to the license. The licensee has also requested a capacity increase to 224 children ages 5 thru 12. The fire clearance for the additional rooms and capacity increase was granted on 7/14/21. LPA observed that the requested classrooms contain hazardous items such as cleaning compounds which were left in cabinets and on counters in areas accessible to children. The director states that the new classrooms will not be immediately used. Prior to using the new classrooms the director will ensure that all cleaning products will latched, locked or placed on high surfaces. The licensee requests to add these classrooms as additional space to use if needed. An updated license will be sent for posting.

See LIC809D for cited deficiency.

The following handouts were provided to the director:
  • Updated Coronavirus 2019 Industry Guidance for Child Care Settings PIN 21-18-CCP.
  • California Department of Public Health updated June 29, 2021 Child Care Industry Guidance.

LPA obtained an updated Emergency Disaster Plan for Child Care Centers- LIC610A, Personnel Report-LIC500, a copy of fire drill log and Parent Handbook.

An exit interview was conducted with the Director Mejia and appeal rights (LIC 9058 1/16) were discussed. The director’s signature on this form acknowledges receipt of these rights. LIC 9213 NOTICE OF SITE VISIT FORM IS REQUIRED TO BE POSTED FOR 30 DAYS. LPA observed the director post notice of site visit.
SUPERVISOR'S NAME: Tashima DanielTELEPHONE: (619) 767-2242
LICENSING EVALUATOR NAME: Grace CurtisTELEPHONE: (619) 767-2235
LICENSING EVALUATOR SIGNATURE:

DATE: 08/05/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2021
LIC809 (FAS) - (06/04)
Page: 3 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108

FACILITY NAME: KCE CHAMPIONS LLC @ HEARST ELEMENTARY
FACILITY NUMBER: 376701101
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/05/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/05/2021
Section Cited

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Food Services:(a) In child care centers providing meals to children, the following shall apply: (19) All food shall be protected against contamination. Contaminated food shall be discarded immediately. This requirement was not met as evidenced by:
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Based on LPA's observation the facility had two containers of expired milk in the facility refrigerator. This poses a potential health and safety risk to children in care.
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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: Tashima DanielTELEPHONE: (619) 767-2242
LICENSING EVALUATOR NAME: Grace CurtisTELEPHONE: (619) 767-2235
LICENSING EVALUATOR SIGNATURE:
DATE: 08/05/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/05/2021
LIC809 (FAS) - (06/04)
Page: 4 of 4