376701509-2-9-2022-20-CC-RGOU-CBGT9D-20220209133145

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 376701509
Report Date: 02/09/2022
Date Signed: 02/09/2022 01:33:50 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 AT JAMUL ELEMENTARY		FACILITY NUMBER:	376701509
ADMINISTRATOR:	ROBYN CLARK		FACILITY TYPE:	840
ADDRESS:	14567 LYONS VALLEY ROAD		TELEPHONE:	(619) 746-9178
CITY:	JAMUL	STATE: CA	ZIP CODE:	91935
CAPACITY:	56	CENSUS: 0	DATE:	02/09/2022
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	11:26 AM
MET WITH:	Danielle Cavanaugh		TIME COMPLETED:	02:00 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 02/09/22 at 11:26 a.m., Licensing Program Analyst (LPA), Rajani Goudreau arrived at the facility to conduct a pre-licensing inspection. Upon arrival LPA, met with Area Site Manager, Danielle Cavanaugh, Director, Marissa Lujan and proceeded to tour the facility. The facility is requested a capacity of 56 school aged children, serving ages transitional kindergarten through 15 years old. This school-age program will operate at Jamul Elementary in the following classrooms: #25 and #26. Facility plans to operate from Monday - Friday from 6:30 a.m. to 8:00 a.m. & 2:45 p.m. to 6:00 p.m., 1:15 p.m. to 6:00 p.m. on minimum school days, and 6:30 a.m. to 6:00 p.m. during breaks, camp, and school closure. Facility is exempt from square footage, toilet, isolation space, outdoor activity space, and fencing requirements, per, H&S 1596.806. The classrooms are equipped with appropriate furniture; including tables, chairs, bookshelves, and other materials for the use of the children. There is a functioning carbon monoxide detector and a first aid kit with required supplies in the classrooms. Disinfectants, cleaning solutions, and other hazardous substances shall be kept inaccessible. Parent's will be utilizing manual sign in and sign out sheets. Required documents including snack menus and COVID-19 postings are posted in classroom #26. The facility will be utilizing boy and girl restrooms located on the front right side of building titled Library/Lab. The toilets in the restrooms provide individual privacy. The restrooms shall not be used simultaneously by children of both sexes. Children are to be escorted and supervised by staff to and from the restrooms. COVID-19 assessment reviewed and discussed. Drinking water is available during indoor and outdoor activities through the use of refillable water containers and disposable cups provided by the program or water bottles brought from home. The outdoor activity space located in the back of the school was inspected and includes a play structure which is safe and age appropriate, sufficient material for cushioning through sand, a shaded rest area for children through the use of trees. Area Manager indicated a movable canopy will also be utilized for outdoor shade as needed. The surface of the outdoor activity space is observed to be free of hazards. See LIC809-C continuation page...

SUPERVISOR'S NAME: Tulam Vu	TELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: Rajani Goudreau	TELEPHONE: (619) 767-2215
LICENSING EVALUATOR SIGNATURE:	DATE: 02/09/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2022

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 AT JAMUL ELEMENTARY	FACILITY NUMBER: 376701509
	VISIT DATE: 02/09/2022

NARRATIVE

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The program will utilize the outdoor eating area near the Library/Lab. LPA discussed proper supervision and placement of staff on the playground to ensure the safety of children at all times. Facility submitted a plan of operation to ensure supervision is in place during outdoor activities and restroom usage.

This facility plans to provide Incidental Medical Services – IMS plan has been submitted and will be reviewed. 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. LPA and Applicant discussed California Megan's Law and LPA provided: www.meganslaw.ca.gov.

A fire clearance for 56 school age children, serving ages TK through 15 years old in classrooms #25 and #26 was granted on December 23, 2021.

An exit interview was conducted with Area Site Manager, Danielle Cavanaugh. The following reports were discussed and provided during the exit interview: LIC809, LIC809-C and appeal rights. After final file review a license for 56 school age children; ages transitional kindergarten through 15 years old in classrooms #25 and #26 will be granted.

SUPERVISOR'S NAME: Tulam Vu	TELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: Rajani Goudreau	TELEPHONE: (619) 767-2215
LICENSING EVALUATOR SIGNATURE:	DATE: 02/09/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2022

LIC809 (FAS) - (06/04)

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