406215807-8-21-2019-17-CC-MKST-BF7S44-20190819133209

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 406215807
Report Date: 08/19/2019
Date Signed: 08/21/2019 12:49:20 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 @ VINEYARD ELEMENTARY		FACILITY NUMBER:	406215807
ADMINISTRATOR:	TAMARA PAYNE-ALEX		FACILITY TYPE:	840
ADDRESS:	2121 VINEYARD DRIVE		TELEPHONE:	(408) 348-1610
CITY:	TEMPLETON	STATE: CA	ZIP CODE:	93465
CAPACITY:	31	CENSUS: 0	DATE:	08/19/2019
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	12:25 PM
MET WITH:	Stephanie Huerta		TIME COMPLETED:	01:35 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 the 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, Stephanie Huerta. The school age center is located on the Vineyard Elementary School campus in Room D1 and the Multi Purpose Room. The Multi Purpose Room will not be used on a regular basis. It will be used occasionally for physical exercise or other activities. Room D1 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 tables, chairs and age appropriate toys, books, and games which are kept in wheeled carts. There is a three (3) gallon water jug for water indoors. Children's belongings are stored in individual laundry baskets. There are restrooms and drinking fountains located outdoors. Site Director stated that children will be escorted to and from the restrooms to ensure their safety. The center will use the "Third Grade Side Play Area." The school grounds are completely fenced, but the outdoor activity area is not 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 6:30am- 8:30am M-F and 1pm-6pm on Wednesdays and 2pm-6pm on Monday, Tuesday, Thursday and Friday. 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: 08/21/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2019

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 @ VINEYARD ELEMENTARY	FACILITY NUMBER: 406215807
	VISIT DATE: 08/19/2019

NARRATIVE

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This is an Amendment fo the Original Report dated 8/19/19.

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 8/2/2021 and has met immunization requirement. Site Director and Staff #2 have completed Mandated Reporter Training per AB1207. Staff # 2 does not have immunization records currently on file.

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 a capacity of 31 children was received on 8/19/19.

License for a 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: 08/19/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2019

LIC809 (FAS) - (06/04)

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