406206848-8-15-2023-17-CC-DMWT-CUQVJ3-20230815162803

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 406206848
Report Date: 08/15/2023
Date Signed: 08/15/2023 04:28:09 PM

Document Has Been Signed on 08/15/2023 04:28 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CENTRAL COAST-CHILD, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME:	KCE CHAMPIONS LLC @ MONTEREY ROAD		FACILITY NUMBER:	406206848
ADMINISTRATOR:	DAWN MARTIN		FACILITY TYPE:	840
ADDRESS:	3355 MONTEREY ROAD		TELEPHONE:	(805) 952-5821
CITY:	ATASCADERO	STATE: CA	ZIP CODE:	93422
CAPACITY:	50	CENSUS: 7	DATE:	08/15/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:53 PM
MET WITH:	Rhianna Merigold		TIME COMPLETED:	04:45 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 08/15/23, at 1:52 PM, Licensing Program Analyst (LPA) Dixie Wright conducted an unannounced one Year Required inspection at this Child Care Center (CCC). LPA met with Rhianna Merigold, Site Supervisor/Teacher of the CCC, and explained the purpose of the inspection LPA toured the interior and exterior of the CCC. The CCC operates out of a classroom (Room 204) on the grounds of Monterey Road Elementary School. The CCC's hours of operation are 7:00 AM to 6:00 PM, Monday - Friday. LPA observed seven children in the CCC along with two teachers (cleared and associated) providing care and supervision. Later during the inspection, other classrooms joined and there were a total of 24 school aged children and two teachers. LPA observed a snack menu posted along with required notices and documents on the classroom's walls. LPAs reviewed children's sign In/Out forms and found the arrival times of children as well as the departure times. The signature of authorized representatives are also noted on the forms. The classroom of the CCC is organized and clean. The classroom has age appropriate furnishings for children in care. The classroom has an operable refrigerator, the refrigerator was empty but they will use it to store snack items that need refrigeration. The CCC provides afternoon snacks. There is available drinking water for children both outside and inside and the CCC. Water sources at the CCC have been tested for lead contaminants and passed the lead testing with no elevated levels of lead found. LPAs observed a carbon monoxide detector on the wall of the classroom which was tested at 2:13 PM and operable. Classroom has a hard wired smoke alarm system with the rest of the school. Disinfectants, cleaning solutions, sharps and medications are stored in a elevated cabinet, inaccessible to children. The restrooms of the CCC are located on school grounds. LPA observed the restrooms to be in sanitary operating condition. Staff members ensure children are escorted to the restrooms and the restrooms are only being used by CCC children at times of use. (CONT. LIC 809-C)

SUPERVISOR'S NAME: Maria Mueller	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Dixie Marie Wright	TELEPHONE: (805) 562-0400
LICENSING EVALUATOR SIGNATURE:	DATE: 08/15/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2023

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
CENTRAL COAST-CHILD, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: KCE CHAMPIONS LLC @ MONTEREY ROAD	FACILITY NUMBER: 406206848
	VISIT DATE: 08/15/2023

NARRATIVE

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The outdoor playground area is enclosed by chain linked and the footing in the area is varied. Play ground equipment in the area is also varied. There are shaded areas and ample space observed.

Staff and children records were reviewed. The children’s records were complete and found to contain emergency contact information as well admission agreements . Staff records were reviewed. All records were complete and current. There is at least one staff with current First Aid/CPR card. Mandated Reporter training is current.

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

Facility representative 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.

No deficiencies noted at this visit.

Exit interview conducted and report was reviewed with the Facility representative Rhianna Merigold.

SUPERVISOR'S NAME: Maria Mueller	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Dixie Marie Wright	TELEPHONE: (805) 562-0400
LICENSING EVALUATOR SIGNATURE:	DATE: 08/15/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2023

LIC809 (FAS) - (06/04)

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