406206846-3-4-2022-17-CC-FVEZ-CC7PKT-20220304102341

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 406206846
Report Date: 03/04/2022
Date Signed: 03/04/2022 10:23:51 AM

Document Has Been Signed on 03/04/2022 10:23 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME:	KCE CHAMPIONS LLC @ SANTA MARGARITA		FACILITY NUMBER:	406206846
ADMINISTRATOR:	D.K. VACA		FACILITY TYPE:	840
ADDRESS:	22070 H STREET		TELEPHONE:	(805) 703-3508
CITY:	SANTA MARGARITA	STATE: CA	ZIP CODE:	93453
CAPACITY:	26	CENSUS: 0	DATE:	03/04/2022
TYPE OF VISIT:	Case Management - COVID-19	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Belinda Tubbs		TIME COMPLETED:	09:30 AM

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 3/4/22, at 9:00 AM, Licensing Program Analysts (LPAs) Francisco Pedroza and Francisca Velazquez conducted an unannounced Case Management – COVID-19 inspection and met with Belinda Tubbs, Director of the abovementioned Child Care Center (CCC). LPAs informed Director of the purpose for the inspection and completed a COVID-19 pre-screening questions prior to the commencement of the inspection. LPAs, along with Director, toured the facility, inside and outside. This inspection is a follow-up on COVID-19 outbreaks reported by facility staff to CCLD between 2/1/22- 2/10/22. CCLD provided a Tele - Rapid Assistance Support Team (RAST) inspection on 6/1/20, where CCLD provided COVID-19 resources, current Childcare Industry Guidance, and a COVID-19 self-assessment guide to the facility. LPAs observed facility staff wearing masks upon arrival to the facility. No children were on site. CCC has disinfectants and cleaning compounds in an elevated cabinet in the classroom that are readily available to staff members but inaccessible to children in care. COVID-19 postings related to mitigations are observed throughout the CCC. Hand washing poster are available by all hand washing sinks. COVID-19 pre-screening questionnaire is conducted prior to all individuals entering the CCC and all individuals with visible COVID-19 symptoms are excluded from care. LPAs discussed facility’s written plan when a staff member or child tests positive for COVID-19 and developing a written communication plan with parents/guardians to share information and guidelines in their preferred language. LPAs discussed COVID-19 Vaccines, Testing, Face coverings, Essential Protective Equipment and Supplies, Physical Distancing, Ventilation, Isolation for Illness, Cleaning and Disinfection, Hand washing, Food Service and Meal Times, How to Respond to Exposures or Outbreaks, and Resilience Tips during the Pandemic. CONT 809-C

SUPERVISOR'S NAME: Maria Mueller	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Francisca Velazquez	TELEPHONE: (805) 883-8244
LICENSING EVALUATOR SIGNATURE:	DATE: 03/04/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2022

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, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: KCE CHAMPIONS LLC @ SANTA MARGARITA	FACILITY NUMBER: 406206846
	VISIT DATE: 03/04/2022

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LPAs reviewed that facility maintains a current COVID-19 Child Care Program Self-Assessment Guide/Mitigation plan. LPAs also provided the following resources:

- Official Public Health and Child Care Guidance for COVID-19 – Updated 2/18/22.
- COVID-19 Child Care Resources:
https://www.cdss.ca.gov/inforesources/cdss-programs/community-care-licensing/child-care-licensing/covid-19-child-care-resources

There were no deficiencies cited during today's inspection.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with Director, Belinda Tubbs.

SUPERVISOR'S NAME: Maria Mueller	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Francisca Velazquez	TELEPHONE: (805) 883-8244
LICENSING EVALUATOR SIGNATURE:	DATE: 03/04/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2022

LIC809 (FAS) - (06/04)

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