376701388-7-2-2019-51-CC-MHEZ-BDPQPL-20190702122056

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 376701388
Report Date: 07/02/2019
Date Signed: 07/02/2019 12:21:00 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 @ MASON - PS		FACILITY NUMBER:	376701388
ADMINISTRATOR:	LIZA SOUVANAH		FACILITY TYPE:	850
ADDRESS:	10340 SAN RAMON DRIVE		TELEPHONE:	(951) 640-4184
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92126
CAPACITY:	24	CENSUS: 0	DATE:	07/02/2019
TYPE OF VISIT:	Annual/Random	ANNOUNCED	TIME BEGAN:	09:11 AM
MET WITH:	Robyn Clark, Facility Representative		TIME COMPLETED:	12:20 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	Licensing Program Analyst, (LPA), Marie Hernandez conducted the annual/random inspection. However, there are no children present at this time as the facility is closed due to a room change. The facility submitted a request for a room change to 802. LPA scheduled an announced inspection with the Facility Representative, Robyn Clark. On 05/21/2019, the Fire Marshal approved the fire clearance for a capacity of 24 children. LPA measured the room; it measured at 1,000 feet divided by 35 square feet equals a capacity of 28. However, the facility is requesting a capacity of 24. The facility is approved for a capacity of 24 effective today, July 2, 2019. The facility also has two waiver approvals for the restrooms and the playground, LPA inspected the classroom and the playground for compliance. The facility has a working carbon monoxide detector. There is drinking water available inside the classroom and in the playground. The facility shall ensure to maintain the appropriate ratios and capacity. The facility shall ensure that the staff are providing the appropriate care & visual supervision of children at all times. There are no bodies of water and/or no fire arms/weapons on the premises during the visit. The facility shall ensure that the children are visually supervised by a teacher at all times. The facility shall ensure that a teacher is supervising no more than 12 children in attendance at any given time. The disinfectants, cleaning solutions, poisons and other dangerous items are inaccessible during the inspection. The storage areas for poisons are locked during the inspection. All materials and surfaces accessible to children are toxic free. The furniture and supplies are age appropriate. The rooms have adequate lighting, and ventilation during the inspection. The floors are found to be clean and safe during the inspection. The restrooms are maintained with operational toilets and faucets with appropriate temperature during the inspection.

SUPERVISOR'S NAME: Tulam Vu	TELEPHONE: (619) 767-2205
LICENSING EVALUATOR NAME: Marie Hernandez	TELEPHONE: (619) 767-2224
LICENSING EVALUATOR SIGNATURE:	DATE: 07/02/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2019

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 @ MASON - PS	FACILITY NUMBER: 376701388
	VISIT DATE: 07/02/2019

NARRATIVE

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Hand soap, paper towels and toilet paper are available during the inspection. The food service area is clean and free of hazards. The menu is posted. There is an adequate supply of food items available for meals and snacks. The outdoor play area was inspected. The facility has maintained the fire/disaster drills; the last drill was conducted on 05/07/2019. The cleaning supplies are kept separate from food. All foods/beverages capable of rapid spoiling are stored in covered containers. The facility appears to be free of insects and rodents during the visit. There is adequate shaded rest area for children during the visit. The toys are age appropriate during the visit. The grounds are free of debris or potential hazards during the visit. Personnel records contain documentation of education and at least one staff member has current CPR and First Aid certification during the visit. A review of staff records on this date indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse clearances or exemptions during the visit. Staff records were reviewed during today’s visit. LPA verified the staff's immunization records and their AB 1207 Mandated Child Abuse Reporting certification. The Lead Exposure handout was discussed and provided.

This facility provides Incidental Medical Services – IMS. 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.

An updated license, to reflect the classroom change, will be mailed to the facility. The facility shall post the license upon receiving it.

No deficiency cited today. An exit interview was conducted and a copy of the report, Notice of Site Visit and the Appeal Rights were provided to the Representative. LPA observed the Representative post the Notice of Site Visit in a prominent place. The Representative states it is understood that this notice must be posted for 30 days.

SUPERVISOR'S NAME: Tulam Vu	TELEPHONE: (619) 767-2205
LICENSING EVALUATOR NAME: Marie Hernandez	TELEPHONE: (619) 767-2224
LICENSING EVALUATOR SIGNATURE:	DATE: 07/02/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2019

LIC809 (FAS) - (06/04)

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