406210355-8-26-2019-17-CC-MKST-BFESW7-20190826141351

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 406210355
Report Date: 08/26/2019
Date Signed: 08/26/2019 02:13:58 PM

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 PS		FACILITY NUMBER:	406210355
ADMINISTRATOR:	D. K. VACA		FACILITY TYPE:	850
ADDRESS:	22070 H STREET		TELEPHONE:	(805) 703-3778
CITY:	SANTA MARGARITA	STATE: CA	ZIP CODE:	93453
CAPACITY:	24	CENSUS: 1	DATE:	08/26/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Belinda Tubbs		TIME COMPLETED:	02:25 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	Licensing Program Analyst (LPA) Melissa Stewart conducted an unannounced facility visit. LPA explained the purpose of the visit to the teacher who was supervising one sleeping child. Teacher explained that Site Supervisor, Belinda Tubbs, was on her lunch break. The preschool is located in classroom #805 and operates Monday - Friday, 7am-6pm. The center was toured inside and outside. All required forms are posted at the main entrance of the center. Menu is posted by the sign in and out sheet. The center uses a computerized sign in and out system and a paper sign in and out as a back up. The classroom is clean and organized with age appropriate furnishings, toys, books and activities. All cleaning supplies and knives are stored and inaccessible to children. The outdoor playground is completely fenced and is equipped with a play structure which has adequate cushioning and shade area. The preschool children use the outdoor playground daily, 10:15am-10:45am. There are drinking fountains indoors and outdoors. Children are escorted to the elementary school restroom and are supervised at all times to ensure that no commingling occurs. Emergency drills are conducted monthly. The most recent drill was held on 8/23/19 at 10:10am. The center has a first aid kit. The teacher reported that there are no children currently enrolled requiring medication. No bodies of water were observed. There are no guns or ammunition stored on site. Site Supervisor, Belinda Tubbs, arrived at 1:30pm. Continued on 809-C

SUPERVISOR'S NAME: Maria Mueller	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Melissa K Stewart	TELEPHONE: (805) 562-0400
LICENSING EVALUATOR SIGNATURE:	DATE: 08/26/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2019

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 PS	FACILITY NUMBER: 406210355
	VISIT DATE: 08/26/2019

NARRATIVE

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This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226.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.

Teacher and child's records were reviewed and found to be complete. Teacher is current with First Aid/CPR which expires on 8/7/21. Teacher has completed AB1207 Mandated Reporter Training and has met immunization requirements.

LPA provided “Effects of Lead Exposure” to be distributed to all families. Site Supervisor was advised to review Quarterly Updates and Provider Information Notices (PINs) which can be accessed on-line at www.ccld.ca.gov.

In areas evaluated, no deficiencies cited.

A copy of this report was left with Site Supervisor, Belinda Tubbs, whose signature on this form confirm receipt of this report.

LPA observed the Notice of Site Visit posted.

SUPERVISOR'S NAME: Maria Mueller	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Melissa K Stewart	TELEPHONE: (805) 562-0400
LICENSING EVALUATOR SIGNATURE:	DATE: 08/26/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2019

LIC809 (FAS) - (06/04)

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