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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 406206848
Report Date: 05/12/2025
Date Signed: 05/12/2025 11:58:10 AM

Document Has Been Signed on 05/12/2025 11:58 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
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME:KCE CHAMPIONS LLC @ MONTEREY ROADFACILITY NUMBER:
406206848
ADMINISTRATOR/
DIRECTOR:		DAWN MARTINFACILITY TYPE:
840
ADDRESS:3355 MONTEREY ROADTELEPHONE:
(805) 952-5821
CITY:ATASCADEROSTATE: CAZIP CODE:
93422
CAPACITY: 50TOTAL ENROLLED CHILDREN: 50CENSUS: 0DATE:
05/12/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:45 AM
MET WITH:Kaylee TorresTIME VISIT/
INSPECTION COMPLETED:
12:25 PM
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On 5/12/25, at 9:45 AM, Licensing Program Analyst (LPA) Matthew Sapien conducted an unannounced annual random Inspection of the abovementioned Child Care Center (CCC). LPA met with Kaylee Torres, Site Director of the CCC, and explained the nature and purpose of the inspection. The LPA, in the company of the Site Director, toured the interior and exterior of the CCC. The CCC operates out of one classroom (classroom 204) and is on the grounds of Monterey Road Elementary School. The CCC utilizes the aforementioned classroom, school playground, and school restrooms.

The CCC's hours of operation are 7:00 AM until 6:00 PM Monday through Friday. There are two cohorts of children with the first being present from 7:00 AM until 8:15 AM with the second being 11:35 AM until 6:00 PM. During the inspection, LPA observed 0 children in care along with 1 additional staff member who is cleared and associated.

The classroom of the CCC is clean and orderly. The classroom has age-appropriate books, equipment, and other furnishings for children in care. The classroom contains a number of closets, cabinets, and other storage containers for childcare equipment, files, and other related items. The bathroom, located on school grounds, was clean and orderly. CCC staff ensure children are escorted to the restrooms and that the restrooms are only being used by CCC children at times of use.

The CCC possesses an operational mini refrigerator that has food items for children and staff. The CCC also has a cabinet that is used as a pantry for children’s snacks. The CCC provides one snack for each cohort of children. Breakfast for the morning cohort of children and lunches for the afternoon cohort of children are supplied by the school. There is available drinking water for children at the CCC via a 5-gallon water dispenser. While outside at the playground, children also have access to water fountains. (CONT. LIC 809-C, Page 2)

Maria MuellerTELEPHONE: (805) 562-0400
Matthew SapienTELEPHONE: (805) 562-0400
DATE: 05/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/12/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: KCE CHAMPIONS LLC @ MONTEREY ROAD
FACILITY NUMBER: 406206848
VISIT DATE: 05/12/2025
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Site Supervisor informed children bring reusable water bottles from home to drink with and that paper cups are also available for children.

CCCs constructed before 1/1/20, are supposed to test their water (used for drinking and food preparation) for lead contamination before 1/1/23, and then every 5-years except after the date of the first test. For child care center licenses issued after 7/1/22, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1-CCP). Through interview and record review, LPA verified that lead testing was completed in accordance to the directives outlined above. Lead testing was conducted and completed in mid-2023.

LPA observed snack menus, required notices, and other relevant licensing documents posted prominently within the classroom of the CCC. LPA also reviewed the children's sign in and sign out forms in the classroom.

LPA observed a carbon monoxide detector in the classroom. A detector was tested at 10:14 AM and was found to be operational. In the classroom, cleaning compounds were stored near the sink area in an elevated cabinet and a locked cabinet. Sharps, like some of the cleaning solutions, were observed in a locked cabinet beneath the sink. Medication was also observed in a lock box in elevated cabinet in the classroom. LPA also observed a First Aid kit backpack in the CCC that contains hydrogen peroxide, band aids, and other appropriate supplies.

The outdoor playground area is enclosed by chain linked fencing throughout. The fence’s entry and exit gates are secure and furnishings in the area are age appropriate. The play structure in the outdoor play area has adequate cushioning material (wood chips) to absorb falls. The footing of the exterior has mixed footing (black top, concrete pavement, and natural grass). Site Supervisor informed LPA that children only have access to a portion of the blacktop and grass area which allows for better supervision of the children. Cones are placed in portions of the playground area that are accessible. There are areas where shade is provided. Site Director attested that children are always supervised while outside.

A sampling of staff and children's records were reviewed. The children’s records were complete and were found to contain emergency contact information as well admission agreements, among other relevant licensing documents and forms. Staff records were reviewed and contained current pediatric CPR and First Aid certifications (EMSA approved) and Mandated Reporter Training certificates among other relevant licensing documents. (CONT. 809-C, Page 3)

SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0400
LICENSING EVALUATOR NAME: Matthew SapienTELEPHONE: (805) 562-0400
LICENSING EVALUATOR SIGNATURE:

DATE: 05/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2025
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
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: KCE CHAMPIONS LLC @ MONTEREY ROAD
FACILITY NUMBER: 406206848
VISIT DATE: 05/12/2025
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The last disaster drill on site occurred on 4/29/25. LPA reminded Director that disaster drills are required every six months by the Department. LPA confirmed that there are no bodies of water, firearms, or ammunition that are stored on site.

This facility does currently provide Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see PIN 22-02-CCP. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514-0383 and link to publication Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/.

Facility representative was reminded that all adults 18 and over, including employees and volunteers, as specified in HSC section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

Facility representative was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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/inspection-process.

During today's visit, no deficiencies were issued.

Facility Representative was provided with Appeal Rights (LIC 9058) and a Notice of Site Visit (LIC 9213). Notice of Site Visit must be posted for 30 days or a civil penalty of $100 may apply.

An exit interview was conducted and report as reviewed with Facility Representative, Kaylee Torres.

SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0400
LICENSING EVALUATOR NAME: Matthew SapienTELEPHONE: (805) 562-0400
LICENSING EVALUATOR SIGNATURE:

DATE: 05/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2025
LIC809 (FAS) - (06/04)
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