393622564-1-22-2020-53-CC-SWIS-BL3V7Z-20200122151158

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 393622564
Report Date: 01/22/2020
Date Signed: 01/22/2020 03:12:04 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833

FACILITY NAME:	KCE CHAMPIONS LLC @ TRACY LEARNING CTR		FACILITY NUMBER:	393622564
ADMINISTRATOR:	ALTER, RUBY		FACILITY TYPE:	840
ADDRESS:	51 E. BEVERLY PLACE		TELEPHONE:	(650) 823-6594
CITY:	TRACY	STATE: CA	ZIP CODE:	95376
CAPACITY:	42	CENSUS:	DATE:	01/22/2020
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	01:44 PM
MET WITH:	Dayna Jesus		TIME COMPLETED:	03:20 PM

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Licensing Program Analyst (LPA) Stacey Williams met with Site Director, Dayna Jesus for the purpose of an annual inspection. LPA observed school age children in classroom P2 which is utilized for the school age program.

LPA toured the building with the Site Director including all activity and classroom spaces, restrooms, food service and outdoor play areas. Toxic and hazardous items are appropriately stored and inaccessible to children. Furniture and equipment are in good condition. Playground equipment and surfaces are free of loose or sharp parts. The areas around or under climbing equipment are cushioned with materials to absorb the fall. Toileting facilities are in safe and sanitary condition. All food was protected against contamination and stored in room P9. Trash cans containing solid waste had lids. Uncontaminated drinking water was readily available to children both indoors and outdoors. Menus were posted. Sign in and out sheets consisted of full legal signatures.

Incidental Medical Services (IMS) policy was discussed. The facility is currently utilizing IMS services and has a plan on file. LPA reviewed child files containing IMS services. LPA viewed medication that was stored in a locked box with instruction on how to administer the medication. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. 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.

SUPERVISOR'S NAME: Maria Mayorga	TELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Stacey Williams	TELEPHONE: (916) 216-7797
LICENSING EVALUATOR SIGNATURE:	DATE: 01/22/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/22/2020

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, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833

FACILITY NAME: KCE CHAMPIONS LLC @ TRACY LEARNING CTR	FACILITY NUMBER: 393622564
	VISIT DATE: 01/22/2020

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A sample of staff and children's records were reviewed. At least one staff member present today has current Pediatric CPR and First Aid certification with an expiration date of October 2021. Child care roster and fire drill logs are being maintained. Information pertaining to their authorized representative, consent for medical treatment and a medical assessment forms were in in all child files. LPA reviewed staff records which included immunization records, mandated reporter completion certificate and documentation of the educational background, training, and/or experience.

There were no Title 22 deficiencies cited in the areas evaluated during today’s inspection.

This facility evaluation report was reviewed and discussed with the Site Director. The implementation of AB 2370 was discussed. LPA provide Site Director with PIN 20-01-CCP. The Quarterly Update newsletter was also provided to the Site Director. Site Director was encouraged to the visit the departments website at WWW.CCLD.CA.GOV for information regarding child care updates, forms, regulations and legislation pertaining child care centers.

Notice of site visit was provided and should remain posted for a period of 30 days for parental review. Appeal rights printed.

SUPERVISOR'S NAME: Maria Mayorga	TELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Stacey Williams	TELEPHONE: (916) 216-7797
LICENSING EVALUATOR SIGNATURE:	DATE: 01/22/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/22/2020

LIC809 (FAS) - (06/04)

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