376701382-8-11-2021-51-CC-SSIO-C5SSYD-20210811141721

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 376701382
Report Date: 08/11/2021
Date Signed: 08/11/2021 02:17:28 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 @ KAVOD		FACILITY NUMBER:	376701382
ADMINISTRATOR:	MARISSA LUJAN		FACILITY TYPE:	840
ADDRESS:	6991 BALBOA AVENUE		TELEPHONE:	(858) 221-3744
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92111
CAPACITY:	140	CENSUS: 0	DATE:	08/11/2021
TYPE OF VISIT:	Case Management - Licensee Initiated	ANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Marissa Lujan		TIME COMPLETED:	02:20 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	On 08/11/2021 at 1:00pm, Licensing Program Analysts (LPAs) Selina Siao and Adrian Mangina conducted an announced case management for the purpose of adding additional rooms to the current license. LPAs met with Site Director Marissa Lujan and conducted a tour of the facility. Facility is currently closed on summer break and Kavod Charter School serve children ages 5-15 will resume on 08/26/2021. This facility is currently licensed for 140 children in four classrooms (multipurpose room, C7, 50 and 52). Licensee representative submitted an application to add a additional five classrooms including Room 51, 53, 71, 73 and 75 as an additional space for the children in care. There is no change in the licensed capacity. Fire clearance was approved on 07/15/2021. Facility has a carbon monoxide detectors in most of the classrooms. All the current licensed classrooms and new classrooms were toured and inspected. The rooms are equipped with age appropriate equipment, furniture, supplies and materials. The children will be using the bathrooms located at three different areas. Men and Women restrooms are located at the hallway near the multipurpose room, restroom located between room 73 and 75 and there is another girls and boys restroom located next to room 51. Children shall be escorted and supervised by staff to and from the restrooms and direct visual observation is required. Outdoor play playground includes the Kindergarten playground located behind classrooms 71, 73 and 75, the Kindergarten playground structure is age appropriate for children ages 2-5 and the playground has soft rubber cushioning. The large black top, grass and swing set will also be use as an outdoor space. The swing set is age appropriate for children 5-12 year old. Staff members should be near the play structures and swing sets when in use to ensure children's safety.

SUPERVISOR'S NAME: Monica Cuddy	TELEPHONE: (619) 767-2249
LICENSING EVALUATOR NAME: Selina Siao	TELEPHONE: (619) 767-2217
LICENSING EVALUATOR SIGNATURE:	DATE: 08/11/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2021

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
CCLD Regional Office, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108

FACILITY NAME: KCE CHAMPIONS LLC @ KAVOD	FACILITY NUMBER: 376701382
	VISIT DATE: 08/11/2021

NARRATIVE

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Facility has a playground and restroom waiver on file. Drinking fountains are available at the Kindergarten playground and portable drinking water will available for the children during both indoor and outdoor time.

The facility appears to be within substantial compliance during the inspection. No correction is needed and the new classrooms will be added to the license effective today.

Notice of Site visit shall be posted for 30 days and failure to keep it posted could result in civil penalty of $100.

SUPERVISOR'S NAME: Monica Cuddy	TELEPHONE: (619) 767-2249
LICENSING EVALUATOR NAME: Selina Siao	TELEPHONE: (619) 767-2217
LICENSING EVALUATOR SIGNATURE:	DATE: 08/11/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2021

LIC809 (FAS) - (06/04)

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