376701389-1-19-2022-51-CC-TDAL-CB2UVY-20220126145553

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 376701389
Report Date: 01/19/2022
Date Signed: 01/19/2022 05:06:13 PM

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
01/10/2022 and conducted by Evaluator Tyra Block

COMPLAINT CONTROL NUMBER: 51-CC-20220110143933

FACILITY NAME:	KCE CHAMPIONS LLC AT SERRA MESA		FACILITY NUMBER:	376701389
ADMINISTRATOR:	DANIELLE CAVANAUGH		FACILITY TYPE:	840
ADDRESS:	2285 MURRAY RIDGE ROAD		TELEPHONE:	(858) 264-9561
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92123
CAPACITY:	56	CENSUS: 22	DATE:	01/19/2022
		UNANNOUNCED	TIME BEGAN:	03:05 PM
MET WITH:	Isabella Alvarez Dela Campa		TIME COMPLETED:	05:15 PM

ALLEGATION(S):

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Facility is not following proper protocol for COVID-19.

INVESTIGATION FINDINGS:

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On 1/19/22, Licensing Program Analyst (LPA), Tyra Block, made an unannounced initial 10-day visit, for the complaint received on 1/10/22, regarding the above allegation. LPA met with Site Supervisor, Isabella Alvarez Dela Campa. Also present was staff Verenice Olavi both were superivising 11 children each, one group was inside and the other outdoors when LPA arrived. All children and staff were observed wearing masks and hand soap was available at each of the 3 handwashing stations. All parents arriving for pick-up were also observed wearing masks.
LPA conducted interviews of children and staff and received a copy of the children’s roster. Based on observation, documentation reviewed, and interviews conducted the allegation was determined to be 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 interview was conducted, and a copy of this report was provided. Facility represenatative, Isabella Alvarez Dela Campa was provided Notice of Site visit. The Notice of Site Visit must be posted for 30 days.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Tashima Daniel	TELEPHONE: (619) 767-2242
LICENSING EVALUATOR NAME: Tyra Block	TELEPHONE: (619) 767-2201
LICENSING EVALUATOR SIGNATURE:	DATE: 01/19/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/19/2022

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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