393622564-9-8-2020-53-CC-SWIS-BTA2RW-20200908173812

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 393622564
Report Date: 09/08/2020
Date Signed: 09/08/2020 05:38:14 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: 8	DATE:	09/08/2020
TYPE OF VISIT:	Case Management - Other	UNANNOUNCED	TIME BEGAN:	03:23 PM
MET WITH:	Dayna Jesus		TIME COMPLETED:	04:30 PM

NARRATIVE

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Due to the COVID-19 pandemic, Licensing Program Analyst (LPA) Stacey Williams conducted a Case management Tele-Visit Video Conferencing with Site Director, Dayna Jesus on September 8, 2020 in lieu of conducting an onsite inspection. Ms. Jesus guided LPA throughout the facility. Today’s census for the program included eight children supervised by three staff.

The purpose of the inspection is to verify the required removal of the individual not cleared to work at the facility is not present. LPA confirmed with Site Director that Katrina Castro has been removed and is not working at the facility. Site Supervisor informed LPA that Ms. Castro was not employed at the facility and was associated to the facility as a hiring formality with the intent of her fingerprint clearances to transfer to a bay area facility. Site Director confirmed that the Area Manager and Hiring Team were notified on September 4, 2020 of the confirmation of removal notification and immediately removed Ms. Castro from the schedule at Santa Clara Bay Club where she had been working. Site Director disclosed she received confirmation for clearance ID prior to Ms. Castro’s employment.

Site Director stated she has not received the mailed notification of confirmation of removal from the Caregiver Background Bureau; however, she has been in communication with the Bay Area regional office who has determined they will terminate employment for Katrina Castro effective September 8, 2020. Site Director confirmed that Ms. Castro has been informed of the notification from the Caregiver Background Bureau. Site Director confirmed that Ms. Castro will not work at KCE Champions LLC @Tracy Learning Center or any facility licensed by Community Care Licensing.

Exit interview conducted and appeal rights were discussed. A copy of this report, Notice of Site Visit, and appeal rights were emailed to the Site Director, Dayna Jesus for acknowledgement, receipt and approval. Hard copy of the report with signature will be on file.

SUPERVISOR'S NAME: Maria Mayorga	TELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Stacey Williams	TELEPHONE: (916) 216-7797
LICENSING EVALUATOR SIGNATURE:	DATE: 09/08/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2020

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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