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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 406210355
Report Date: 03/06/2020
Date Signed: 03/06/2020 01:28:07 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 PSFACILITY NUMBER:
406210355
ADMINISTRATOR:D. K. VACAFACILITY TYPE:
850
ADDRESS:22070 H STREETTELEPHONE:
(805) 703-3778
CITY:SANTA MARGARITASTATE: CAZIP CODE:
93453
CAPACITY:24CENSUS: 5DATE:
03/06/2020
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:35 AM
MET WITH:Belinda TubbsTIME COMPLETED:
01:35 PM
NARRATIVE
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On 3/6/20 at 11:35am, Licensing Program Analyst (LPA) Melissa Stewart arrived at preschool classroom #805 and observed Staff 1 (S1) supervising 5 children eating lunch outside at a picnic table. Within 5 minutes, Staff 2 (S2) returned from a toilet break. LPA explained that the purpose of the visit was to conduct an unannounced Annual Required- 1 Year inspection. The preschool operates, Monday - Friday, 7am - 6pm. All required forms, including monthly menu, are posted at the main entrance of the classroom. At 11:43am, LPA reviewed the sign in and out sheets which corresponded with the number of children present. LPA reviewed staff files and a sample of children's files. At 11:54am, LPA observed that S1 does not have any early childhood education units. Both S1 and S2 have current Pediatric CPR and First Aid certification, have completed AB 1207 Mandated Reporter Training and have met immunization requirements per SB 792. The classroom was observed to be clean, organized and free of toxins. LPA observed indoor activity centers containing books, puzzles, manipulatives, blocks, arts and crafts and dramatic play materials. Site Director, Belinda Tubbs, arrived at the center at 12pm. LPA reviewed S1s personnel file with Site Director who verified that S1 does not have any early childhood education units. LPA provided and reviewed with Site Director the California Code of Regulations 101216.2- Teacher Aide Qualifications and Duties and a list of Early Childhood Education class titles.

The center conducts and documents monthly emergency and disaster drills. The most recent drill was held on 2/20/20. LPA observed that the preschool has first aid kits and disaster preparedness equipment. The carbon monoxide detector was tested and found to be operational. Site Director reported that there are no firearms, ammunition or bodies of water on the premises. Continued on 809-C
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Melissa K StewartTELEPHONE: (805) 689-6267
LICENSING EVALUATOR SIGNATURE:

DATE: 03/06/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2020
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 3
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: 03/06/2020
NARRATIVE
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The preschool has scheduled use of both the kindergarten playground and the kindergarten restrooms to avoid co-mingling with school age children. LPA observed the outdoor activity area contains an age appropriate climbing structure with wood chips to absorb a fall. Drinking water is available both inside and outside.

This facility provides Incidental Medical Services – IMS. Staff 2 reported that there are no children currently enrolled who require Incidental Medical Services. 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: www.ada.gov/childqanda.htm.

Site Director reported that the “Effects of Lead Exposure” brochure is distributed to all families at time of enrollment. Site Director was advised to review Quarterly Updates and Provider Information Notices (PINs) which can be accessed on-line at www.ccld.ca.gov.

Deficiencies cited based on LPA observation, interviews conducted and record review in accordance with the California Code of Regulations, Title 22, see LIC809D. An exit interview was conducted and Plans of Corrections were reviewed and developed with the Licensee. A copy of this report and appeal rights were discussed and left with Site Director, Belinda Tubbs, whose signature on this form confirm receipt of these documents.

LPA observed Notice of Site Visit posted.

SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Melissa K StewartTELEPHONE: (805) 689-6267
LICENSING EVALUATOR SIGNATURE:

DATE: 03/06/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2020
LIC809 (FAS) - (06/04)
Page: 3 of 3
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/06/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/06/2020
Section Cited

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101216.2 Teacher Aide Qualifications and Duties (d) An aide assisting a fully qualified teacher...shall meet the following requirements:(1) Completion of six postsecondary semester units...in early childhood education or child dev... (e)An aide shall work only under the direct supervision of a teacher.
This requiremnt is not met as evidenced by:
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Based on observation, interview and record review, Site Director did not ensure that S1 had met the educational requirement to qualify S1 as an Aide; S1 was left alone with children for less than 5 minutes which poses a potential risk to the health, safety and/or personal rights of children in care.
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requirement to LPA prior to counting S1 in the ratio.

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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Melissa K StewartTELEPHONE: (805) 689-6267
LICENSING EVALUATOR SIGNATURE:
DATE: 03/06/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/06/2020
LIC809 (FAS) - (06/04)
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