406210355-10-9-2024-17-CC-MSAN-D9VRV4-20241009132055

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 406210355
Report Date: 10/09/2024
Date Signed: 10/09/2024 01:21:08 PM

Document Has Been Signed on 10/09/2024 01:21 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
SANTA BARBARA CC RO, 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: 4	DATE:	10/09/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Taylor Brown		TIME COMPLETED:	11:00 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 10/9/24, at 9:15 AM, Licensing Program Analysts (LPAs) Elvin Baddley and Matthew Sapien conducted an unannounced Annual Random Inspection of the abovementioned Child Care Center (CCC). LPAs met with Taylor Brown, Site Supervisor of the CCC, and explained the purpose of the inspection. LPAs, in the company of Site Supervisor, toured the interior and exterior of the CCC. The CCC operates out of a classroom 805 on the grounds of Santa Margarita Elementary School. The CCC's hours of operation are 7:00 AM until 6:00 PM, Monday through Friday. During the inspection, LPAs observed four children in care along with one teacher (cleared and associated) providing care and supervision. The classroom of the CCC is clean and orderly. The classroom has age appropriate toys, books, and other furnishings for children in care. The classroom has an operable refrigerator which contains food items for the CCC's children. The CCC provides snacks for children in care, while lunches are supplied by parents. There is filtered drinking water available for children in care both inside and outside the CCC. Children also bring bottled water from their respective homes. CCCs constructed before 1/1/20, 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). LPAs verified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP. LPAs observed snack menus and required notices and other relevant documents posted prominently on the classroom's walls. LPAs also reviewed the children's sign in/sign out forms and found the arrival times of children, along with the departure times. The signatures of authorized representatives were also present in the forms. LPAs observed a carbon monoxide detector in the classroom, which was tested at 9:58 AM, and was found (CONT. LIC 802-C)

SUPERVISOR'S NAME: Maria Mueller	TELEPHONE: (805) 562-0400
LICENSING EVALUATOR NAME: Matthew Sapien	TELEPHONE: (805) 562-0400
LICENSING EVALUATOR SIGNATURE:	DATE: 10/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2024

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
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: KCE CHAMPIONS LLC @ SANTA MARGARITA PS	FACILITY NUMBER: 406210355
	VISIT DATE: 10/09/2024

NARRATIVE

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to be operable. Cleaning compounds and medication are stored in elevated cabinets in the CCC. In addition to the medication being stored in an elevated area inaccessible to children in care, the medication is stored within a secure lock box. Sharps were also observed in a cabinet at the teacher's desk inaccessible to children in care. CCC also has a First Aid kit in the classroom.

The restrooms of the CCC are located on the elementary school ground, outside of the classroom.

All restrooms are in sanitary operating condition. The CCC shares the restrooms with other children in the school, however, the CCC children are monitored by CCC staff when using the restrooms.

The outdoor playground area is enclosed by chain link fencing. The fence’s entry/exit gates are secured and furnishings in the area are age appropriate. The play structure in the outdoor play area has adequate cushioning material (wood bark) to absorb falls. Shade is provided by trees in the area, in addition to building overhangs and table umbrellas. Play times in the outdoor area are staggered to ensure children in care do not commingle with school age children. No bodies of water were observed on site.

Staff and children records were reviewed. The children’s records were complete and 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), along with Mandated Reporter certifications. Facility records show that the last fire drill on site occurred on 9/24/24. LPAs confirmed that there are no firearms or ammunition are stored on site.

This facility does currently provide Incidental Medical Services – IMS. LPAs reviewed storage of medication supplies. LPAs also reviewed children’s, personnel, and administrative records in relation to IMS services. 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 (TTY) 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 (CONT. 809-C, Page 3)

SUPERVISOR'S NAME: Maria Mueller	TELEPHONE: (805) 562-0400
LICENSING EVALUATOR NAME: Matthew Sapien	TELEPHONE: (805) 562-0400
LICENSING EVALUATOR SIGNATURE:	DATE: 10/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2024

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 @ SANTA MARGARITA PS	FACILITY NUMBER: 406210355
	VISIT DATE: 10/09/2024

NARRATIVE

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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.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Facility representative, Taylor Brown.

SUPERVISOR'S NAME: Maria Mueller	TELEPHONE: (805) 562-0400
LICENSING EVALUATOR NAME: Matthew Sapien	TELEPHONE: (805) 562-0400
LICENSING EVALUATOR SIGNATURE:	DATE: 10/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2024

LIC809 (FAS) - (06/04)

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