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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 376701101
Report Date: 11/16/2022
Date Signed: 11/16/2022 04:55:28 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/13/2022 and conducted by Evaluator Tyra Block
PUBLIC
COMPLAINT CONTROL NUMBER: 51-CC-20220913091141
FACILITY NAME:KCE CHAMPIONS LLC AT HEARST ELEMENTARYFACILITY NUMBER:
376701101
ADMINISTRATOR:ALMA MEJIAFACILITY TYPE:
840
ADDRESS:6230 DEL CERRO BOULEVARDTELEPHONE:
(916) 387-5761
CITY:SAN DIEGOSTATE: CAZIP CODE:
92120
CAPACITY:224CENSUS: 32DATE:
11/16/2022
UNANNOUNCEDTIME BEGAN:
04:18 PM
MET WITH:Sarah RehartTIME COMPLETED:
04:40 PM
ALLEGATION(S):
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Staff are not adequately supervising children in care.
INVESTIGATION FINDINGS:
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On 11/16/22, licensing Program Analyst (LPA), Tyra Block, conducted an unannounced visit to deliver the findings for the complaint received 9/14/22 for the above allegation.
Based on the information obtained during interviews, observations, and documentation reviewed it is determined that there is not sufficient evidence to prove staff was not adequately supervising children. Staff acknowledged children were hiding in the class and a count was conducted which confirmed they were not accounted for, however, the children were discovered in the class and had not eloped.
It is determined that the allegation is UNSUBSTANTIATED. Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.
An exit interviewe was conducted with facility representative, Sarah Rehart. Appeal Rights were discussed. Notice of Site Visit was provided and must remain posted for 30 days.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Tashima DanielTELEPHONE: (619) 767-2242
LICENSING EVALUATOR NAME: Tyra BlockTELEPHONE: (619) 767-2201
LICENSING EVALUATOR SIGNATURE:

DATE: 11/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/13/2022 and conducted by Evaluator Tyra Block
PUBLIC
COMPLAINT CONTROL NUMBER: 51-CC-20220913091141

FACILITY NAME:KCE CHAMPIONS LLC AT HEARST ELEMENTARYFACILITY NUMBER:
376701101
ADMINISTRATOR:ALMA MEJIAFACILITY TYPE:
840
ADDRESS:6230 DEL CERRO BOULEVARDTELEPHONE:
(916) 387-5761
CITY:SAN DIEGOSTATE: CAZIP CODE:
92120
CAPACITY:224CENSUS: DATE:
11/16/2022
UNANNOUNCEDTIME BEGAN:
04:18 PM
MET WITH:Sarah RehartTIME COMPLETED:
04:40 PM
ALLEGATION(S):
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2
3
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7
8
9
Staff are not following sign in and sign out procedures.
INVESTIGATION FINDINGS:
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On 11/16/22, licensing Program Analyst (LPA), Tyra Block, conducted an unannounced visit to deliver the findings for the complaint received 9/14/22 for the above allegation.
It was alleged sign in and out procedures were not followed and ID not checked. Based on the information obtained during interviews, observations, and documentation reviewed it is determined that that the allegation is valid.
On at least one occasion a child was not signed out of the program by a parent or authorized representative. It is unclear if ID was checked according to program policy.
The preponderance of the evidence has been met, therefore, the above allegation is found to be SUBSTANTIATED. The deficiency is being cited on the attached LIC 9099D. An exit interview was conducted with facility representative, Sarah Rehart. Appeal Rights were discussed. Notice of Site Visit was provided and must remain posted for 30 days.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Tashima DanielTELEPHONE: (619) 767-2242
LICENSING EVALUATOR NAME: Tyra BlockTELEPHONE: (619) 767-2201
LICENSING EVALUATOR SIGNATURE:

DATE: 11/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/17/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 51-CC-20220913091141
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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 AT HEARST ELEMENTARY
FACILITY NUMBER: 376701101
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/16/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/23/2022
Section Cited
CCR
101229.1(b)
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101229.1(b)- Sign in and Sign Out:The person who brings the child to, and removes the child from, the center shall sign the child in/out. This requirement was not met as evidenced by:
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Site Supercisor states staff will be at the parent table at all times to ensure parents are signing out correctly and will provide written plan to LPA by POC due date of 11/23/22.
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Based on interviews and record review a child was not signed out of the program at pick up on at least one occasion on 9/7/22. 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: Tyra BlockTELEPHONE: (619) 767-2201
LICENSING EVALUATOR SIGNATURE:

DATE: 11/16/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 3