434404972-8-24-2021-52-CC-JWIS-C67VEC-20210824162206

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434404972
Report Date: 08/24/2021
Date Signed: 08/24/2021 04:22:17 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME:	KCE CHAMPIONS LLC @ SANTA RITA ELEMENTARY		FACILITY NUMBER:	434404972
ADMINISTRATOR:	NIKOLE MILLER		FACILITY TYPE:	840
ADDRESS:	700 LOS ALTOS AVENUE		TELEPHONE:	(650) 946-7791
CITY:	LOS ALTOS	STATE: CA	ZIP CODE:	94022
CAPACITY:	56	CENSUS: 18	DATE:	08/24/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	03:10 PM
MET WITH:	Jacqueline Navarro		TIME COMPLETED:	04:30 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	On 8/24/2021, Licensing Program Analyst (LPA) Jonathan Williams met with Director (Jacqueline Navarro) for a Required 1-Year Inspection. Present for this inspection are the Director, one fully qualified teacher, and 18 school-age children in care. The facility operates in a single classroom located on the premises of Santa Rita Elementary. Facility operating hours are 7am-8:45am and 12pm-6pm M-F until 9/10/2021, when operating hours will change to 7am-8:45am and 2:30pm-6pm M-F. The facility was toured to conduct a health and safety inspection. At 3:12pm, LPA toured the facility classroom. The classroom is tidy and clean with heating and ventilation for safety and comfort. There are safe age-appropriate toys and learning materials available to children throughout the classroom. All hazardous materials and toxins including disinfectants and cleaning solutions were observed to be made inaccessible to children during today's inspection. Furniture accessible to children was observed to be age-appropriate, in operable condition, and free of loose, sharp, or pointed parts. The kitchen is free of litter, garbage, and evidence of rodents or other vermin during this inspection. Food is protected from contamination and, per staff, contaminated food is discarded immediately. Uncontaminated drinking water is available to children inside and outside the facility. Toilets and sinks were found to be in operable condition. LPA observed adequate amounts of paper towels and hand soap available to children in the bathroom during today's inspection. No cleaning supplies were observed to be accessible to children during today's inspection. At 3:29pm, LPA reviewed sign in/sign out sheet. LPA observed 23 signatures out of 20 children present in the facility during today's inspection. Three children were not signed out by an authorized representative.

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR NAME: Jonathan Williams	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 08/24/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2021

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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: KCE CHAMPIONS LLC @ SANTA RITA ELEMENTARY	FACILITY NUMBER: 434404972
	VISIT DATE: 08/24/2021

NARRATIVE

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At 3:45pm, LPA toured the outdoor play area. All play equipment was observed to be operable and age-appropriate during this inspection. Areas around swings, slides, and high climbing equipment have cushioning material to absorb falls. There are no pools, hot tubs, ponds, or any other bodies of water accessible to children during today's inspection.

The facility has a fully charged 3A40BC fire extinguisher, working smoke detector, working carbon monoxide detector, and working telephone. At least one staff member has current CPR/1st Aid certificate and all staff have Mandated Reporter Training certificates. The facility is in ratio today. Children's files and staff files were reviewed for proper documentation. All required forms are posted in public view, including menus. Facility roster was obtained.

Incidental Medical Services (IMS) policy was discussed. This facility does not provide IMS to children in care at this time. 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.”

Director was reminded that ALL assistants, volunteers, frequent visitors, or adults present in the facility that are 18 years of age or older must be fingerprint cleared and associated to this facility prior to being in the presence of children in care or an immediate civil penalty will be assessed from $100 to $3000 per person, per incident.

Director was reminded that California Law requires licensed Child Care Centers to report unusual incidents or injuries to children in care to child's parents and to the Department of Social Services using the Unusual Incident/Injury form (LIC 624). Incidents must be reported within 24 hours by phone, fax, or electronic mail. LPA informed the Director that all forms can be downloaded at www.ccld.ca.gov and encouraged the Director to email childcareadvocatesprogram@dss.ca.gov to be included in the Child Care Quarterly Updates distribution list. The Director was also reminded that Mandated Reporter Training ("General" and "Child Care Providers") is required for all staff and is to be renewed every 2 years by visiting www.mandatedreporterca.com.

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR NAME: Jonathan Williams	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 08/24/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2021

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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: KCE CHAMPIONS LLC @ SANTA RITA ELEMENTARY	FACILITY NUMBER: 434404972
	VISIT DATE: 08/24/2021

NARRATIVE

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There are no deficiencies cited. A Notice of Site Visit was provided to the Director. LPA reminded the Director to post the Notice of Site Visit where it is clearly visible inside the facility for a period of 30 days after the date of today's inspection. Appeal rights were provided to the Director and the signature on this form acknowledges receipt of these rights.

Exit interview was conducted.

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR NAME: Jonathan Williams	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 08/24/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2021

LIC809 (FAS) - (06/04)

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