406206846-3-4-2022-17-CC-FPEA-CC7PPQ-20220304102954

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 406206846
Report Date: 03/04/2022
Date Signed: 03/04/2022 10:30:04 AM

Document Has Been Signed on 03/04/2022 10:30 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:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:31 AM
MET WITH:	Belinda Tubbs		TIME COMPLETED:	10:45 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 March 4, 2022 at 9:31 AM, Licensing Program Analysts (LPAs) Francisco Pedroza and Francisca Velasquez conducted an unannounced Annual/Random inspection. LPAs met with facility Director Belinda Tubbs and advised her the purpose of the inspection. Director Provided LPAs a tour of the facility inside and out. There were no children in care at the time of the inspection. Facility is located on a local elementary school site. Licensing required notices were posted prominently on the wall at the entrance of the facility. The facility has two (2) classrooms for children in care. The classrooms have age appropriate games, activities, and furniture available for children in care. LPAs observed and reviewed the posted snack menu. The center provides one snack daily and children bring their lunch from home. The outdoor playground has age appropriate toys, equipment, and structures available for the children. The playground has an ample amount of shade available. The center has water available for children inside and out. Children bring their own water bottles and can fill them from the water fountain. Center uses written sign-in/out logs at the entrance of the facility. A sampling of children and staff records were reviewed. Teachers have required qualifications. Teachers present have current Pediatric First Aid/CPR certificates that expire on 7/28/2022. Teachers present have current AB 1207 Mandated Reporter Training certificates that expire on 9/11/2022. LPAs verified SB 792 Child Care Adult Immunization and Tuberculosis Requirements. LPA's spoke with Director about current Covid-19 guidelines. Facility staff were observed wearing face masks during the inspection. No deficiencies were cited during today's visit. Continued on 809-C

SUPERVISOR'S NAME: Maria Mueller	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Francisco Pedroza	TELEPHONE: (805) 689-6267
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

NARRATIVE

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Incidental Medical Services (IMS) policy was discussed. 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

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

Director was reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the Director

SUPERVISOR'S NAME: Maria Mueller	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Francisco Pedroza	TELEPHONE: (805) 689-6267
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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