406215806-8-21-2019-17-CC-MKST-BF7QER-20190819120645

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 406215806
Report Date: 08/19/2019
Date Signed: 08/21/2019 12:21:32 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 @ TEMPLETON ELEMENTARY		FACILITY NUMBER:	406215806
ADMINISTRATOR:	TAMARA PAYNE-ALEX		FACILITY TYPE:	840
ADDRESS:	215 EIGHTH STREET		TELEPHONE:	(408) 348-1610
CITY:	TEMPLETON	STATE: CA	ZIP CODE:	93465
CAPACITY:	31	CENSUS:	DATE:	08/19/2019
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	10:10 AM
MET WITH:	Lily Ruelas		TIME COMPLETED:	12:10 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	This is an Amendment of Original Report dated 8/19/19. Licensing Program Analyst (LPA) Melissa Stewart conducted a pre licensing visit and met with Area Manager, Tamara Payne-Alex and Site Director, Lily Ruelas. The school age center is located on the Templeton Elementary School campus in the Multi Purpose Room and the Library. The multi purpose room will be the main indoor activity area. All required documents are posted on the communication board near the computerized sign in and sign out. Site Director will maintain updated "head count" sheets on a clipboard along with emergency contact information for all children. Snacks, medications, and art supplies are kept in two locking storage cabinets. The medication is stored in a box with a child-proof lock. LPA observed age appropriate toys, books, games which are kept in wheeled carts. There is a three (3) gallon water jug for water indoors. There are drinking fountains outdoors. There are tables and benches and a small carpeted "library area." The stage area and school kitchen are off-limits to the school age center children. The kitchen will be kept locked at all times. The stage area will be separated from the indoor activity area by individual laundry baskets which serve as storage baskets for each child's belongings. The Library will not be used on a regular basis. It will only be used when the school is using the multi purpose room. There are men's and women's restrooms in the hallway. There is a door that exits to the outdoor activity area near the restrooms. This door will not be kept locked. Site Director stated that children will be escorted to and from the restrooms to ensure their safety. LPA observed outdoor area that is not completely fenced. 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: 08/19/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2019

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 @ TEMPLETON ELEMENTARY	FACILITY NUMBER: 406215806
	VISIT DATE: 08/19/2019

NARRATIVE

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This is an Amendment of Original Report dated 8/19/19. The center will use the picnic tables and open area directly outside of the multi purpose room and library. Children may occasionally use the grass area which is completely fenced. Children will be supervised at all times. Area Manager stated that she will have children from Kindergarten through 6th grade. Center will operate from 1pm-6pm on Wednesdays and 2pm-6pm on Monday, Tuesday, Thursday and Friday.

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

Staff files were reviewed. Site Director has current CPR/First aid which expires on 2/28/2021. Staff have completed Mandated Reporter Training per AB1207 and have met immunization requirement.

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

Fire Clearance for 31 children was received on 8/19/19.

License for School Age Center is granted as of 8/19/19.

SUPERVISOR'S NAME: Maria Mueller	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Melissa K Stewart	TELEPHONE: (805) 562-0400
LICENSING EVALUATOR SIGNATURE:	DATE: 08/21/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2019

LIC809 (FAS) - (06/04)

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