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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376701389
Report Date: 09/02/2021
Date Signed: 09/02/2021 04:31:01 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 @ SERRA MESAFACILITY NUMBER:
376701389
ADMINISTRATOR:DANIELLE CAVANAUGHFACILITY TYPE:
840
ADDRESS:2285 MURRAY RIDGE ROADTELEPHONE:
(858) 264-9561
CITY:SAN DIEGOSTATE: CAZIP CODE:
92123
CAPACITY:56CENSUS: 23DATE:
09/02/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Daniellel CavanaughTIME COMPLETED:
04:45 PM
NARRATIVE
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On 9/2/21 at 3:00 PM, Licensing Program Analyst (LPA) Keturah Lane visited the facility to conduct an annual inspection. Upon arrival LPA met with Director Danielle Cavanaugh and proceeded to tour the facility. During today's inspection, there were 23 children with 3 staff members (Director, Lauren Ames and Isabelle Alvarez de la Campa) in the multi-purpose room. Rooms 104 and 204 are currently not being used. Appropriate ratios and capacity were observed. Appropriate care & visual supervision were also observed during the inspection while children were transitioning from indoor to outdoor play.
Furniture and age appropriate equipment is in good condition. Rooms have adequate heating, lighting, ventilation. Floors appear to be clean and safe. Drinking water is readily accessible. Bathrooms are maintained with operational toilets and faucets with appropriate temperature. Bathrooms are not used simultaneously by children of both sexes and provide individual privacy. Paper towels and toilet paper are available. Bathroom is lighted and has ventilation. Food service area consists of a kitchen which is clean and free of hazards. Kitchen is only used to store snacks and is shared with the church and charter school onsite. Menu is posted. Adequate food is available for snacks. Cleaning supplies are kept separate from food and are inaccessible to children. Storage containers for solid waste have tight-fitting covers and are kept in good repair. Storage areas for poisons are locked. Director stated there are no firearms or other weapons on the premises. All foods/beverages capable of rapid spoiling are stored in covered containers at 45 F or less. The facility appears to be free of insects and rodents. There is an operational carbon monoxide detector at the facility.
Outdoor play area is a fenced playground with sufficient material for cushioning. There are no bodies of water or weapons at this facility. Climbing structures and slides are securely fixed to the ground. Area has large canopies used for shade. Equipment is age appropriate. Area has drinking water readily accessible (children use water bottles) and grounds are free of debris or potential hazards. There is one area of the upper chain length fence by the basketball court that has pulled away at the bottom and needs to be secured so that children’s hands do not get caught underneath. (see LIC9210 TA) (continued on LIC809-C...)
SUPERVISOR'S NAME: Monica CuddyTELEPHONE: (619) 767-2249
LICENSING EVALUATOR NAME: Keturah LaneTELEPHONE: (619) 767-2223
LICENSING EVALUATOR SIGNATURE:

DATE: 09/02/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/02/2021
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 3
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 @ SERRA MESA
FACILITY NUMBER: 376701389
VISIT DATE: 09/02/2021
NARRATIVE
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LPA reviewed medication storage. Personnel records contain health screening documentation, required immunizations and at least one staff member has current CPR and First Aid certifications. Two staff members have not renewed mandated reporter training. Sign ins were reviewed. Children’s records contain admission agreements. 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. LPA Lane requested updated LIC500 Personnel Report and LIC9040 Facility roster.

Pursuant to Title 22 of the CA Code of Regulations, the following Type B deficiency was cited (refer to LIC 809-D).

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.

An exit interview was conducted with the Director. The Director was provided a copy of their appeal rights (LIC 9058) along with the report (LIC809, LIC809-C, LIC809-D) and their signature on this form acknowledges receipt of these rights. The LIC 9213 (Notice of Site visit) was posted during today's visit. Notice of Site Visit must remain posted for 30 days.
SUPERVISOR'S NAME: Monica CuddyTELEPHONE: (619) 767-2249
LICENSING EVALUATOR NAME: Keturah LaneTELEPHONE: (619) 767-2223
LICENSING EVALUATOR SIGNATURE:

DATE: 09/02/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/02/2021
LIC809 (FAS) - (06/04)
Page: 2 of 3
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 @ SERRA MESA
FACILITY NUMBER: 376701389
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/02/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/14/2021
Section Cited

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1596.8662 …training for mandated reporter who is licensed day care provider…(b)(1)On or before March 30, 2018, a person who…is a licensed child care provider…or employee of a licensed child care facility shall complete the mandated reporter training…This requirement was not met as evidenced by…
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Based on record review and Director statement, Director and staff member Lauren Ames did not renew the mandated reporter training, which 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: Monica CuddyTELEPHONE: (619) 767-2249
LICENSING EVALUATOR NAME: Keturah LaneTELEPHONE: (619) 767-2223
LICENSING EVALUATOR SIGNATURE:
DATE: 09/02/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/02/2021
LIC809 (FAS) - (06/04)
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