406210355-10-20-2022-17-CC-EBAY-CKDPS8-20221020113354

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 406210355
Report Date: 10/20/2022
Date Signed: 10/20/2022 11:34:57 AM

Document Has Been Signed on 10/20/2022 11:34 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
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: 7	DATE:	10/20/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Belinda Tubbs		TIME COMPLETED:	11:45 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 10/20/22, at 9:30 AM, Licensing Program Analyst (LPA) Elvin Baddley conducted an unannounced One Year Required Inspection the abovementioned Child Care Center (CCC). LPA met with Belinda Tubbs, the Director of the CCC and explained the purpose of the inspection. LPA, in the company of Director , toured the interior and exterior of the CCC. The CCC operates out of a classroom (Room 805) on the grounds of Santa Margarita Elementary School. The CCC's hours of operation are 7:00 AM to 5:30 PM, Monday - Friday. During the inspection LPA observed seven children in the CCC along with two teachers (cleared and associated) providing care and supervision. 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 which contains food items consumed by the CCC's children. Food items in the CCC's refrigerator are labeled. The CCC provided snacks for children in care while lunches are provided by parents. Staff member view lunches to ensure children's lunches contain food items from the essential food groups and are void of junk foods. There is available drinking water for children inside and outside the classroom. Children also use individual bottled water brought from their respective homes. LPA reminded Director of the need to have the CCC's water supply tested for lead containments. LPA observed a snack menu and required notices and documents posted on the classroom's walls. LPA reviewed children's In/Out forms and found the arrival times of children as well as the departure times. The signatures of authorized representatives are also noted. LPA observed a carbon monoxide detector in the classroom which was tested (9:30 AM) and found to be operable. Disinfectants, cleaning solutions, medication and sharps are stored in elevated cabinets in the CCC. The CCC also has a First Aid kit along with a backpack containing emergency supplies. LPA notes the previous items mentioned are inaccessible to children and outside the reach of the children in care. The restrooms of the CCC are located on the elementary school ground's, outside of the classroom. (CONT. LIC 802-C)

SUPERVISOR'S NAME: Maria Mueller	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Elvin Baddley	TELEPHONE: (805) 635-4697
LICENSING EVALUATOR SIGNATURE:	DATE: 10/20/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2022

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: 10/20/2022

NARRATIVE

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LPA observed the restrooms to be in sanitary operating condition. Children in care are escorted to the restroom by staff members who stand in proximity of the restrooms during use.

The outdoor playground area is enclosed by chain linked. 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 materials to absorb falls. Shade is provided by trees in the area. Play times in the outdoor area are staggered to ensure children in care do not commingle with school age children. No bodies of water are observed on site.

Staff and children records are reviewed. The children’s records were complete and found to contain emergency contact information as well admission agreements, among other things. Staff records were reviewed and contained current pediatric CPR and First Aid certifications (EMSA approved) along with Mandated Reporter certifications. Facility record show the last fire drill on site occurred on 10/11/22. Director informed LPA no firearms or ammunition are stored on site.

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.

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 Belinda Tubbs.

SUPERVISOR'S NAME: Maria Mueller	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Elvin Baddley	TELEPHONE: (805) 635-4697
LICENSING EVALUATOR SIGNATURE:	DATE: 10/20/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2022

LIC809 (FAS) - (06/04)

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