434415372-11-7-2019-07-CC-SYIP-BHPTDY-20191107133905

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434415372
Report Date: 11/06/2019
Date Signed: 11/07/2019 01:39:11 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME:	KCE CHAMPIONS LLC @ ROD KELLEY ELEMENTARY		FACILITY NUMBER:	434415372
ADMINISTRATOR:	HELEN DE LA CRUZ		FACILITY TYPE:	840
ADDRESS:	8755 KERN AVENUE		TELEPHONE:	(408) 707-9381
CITY:	GILROY	STATE: CA	ZIP CODE:	95020
CAPACITY:	64	CENSUS: 14	DATE:	11/06/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	04:27 PM
MET WITH:	Gloria Castro		TIME COMPLETED:	05:30 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	Licensing Program Analyst (LPA) Samantha Yip conducted an unannounced annual/random inspection. LPA meet with Site Director Gloria Castro and explained the purpose of the inspection. There were 14 children and 3 staff present during the inspection. The teacher child ratio was observed to be in compliance during the inspection. Facility is located on the Rod Kelly Elementary School campus. License, Parent’s Rights, and Emergency Disaster Plan were observed to be posted. The facility was toured inside and outside with Director. The facility observed to be clean, safe, sanitary, and in good repair. Disinfectants, cleaning solutions, and all other items that are dangerous to children were observed to be securely stored and inaccessible to children. The furniture and the equipment, such as tables and chair were age-appropriate and in good condition; free of sharp or loose, or pointed parts. The floors were clean and free of tripping hazard. LPA observed there is sufficient amount of age-appropriate toys for children in care. Restrooms for children’s use were observed to be clean. Site Director stated that there are no weapons stored on the premise. LPA observed a fully charged fire extinguisher and a carbon monoxide detector. The facility does use the grass area and the playground area on the elementary school campus. There is resilient material around play structure to absorb falls. The area is fenced. LPA did not observe any bodies of water during today's inspection. ----------------------continues on 809 dated 11/06/2019 page 1-------------------------------

SUPERVISOR'S NAME: Anthony Studebaker	TELEPHONE: (408) 324-2148
LICENSING EVALUATOR NAME: Samantha Yip	TELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:	DATE: 11/06/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2019

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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: KCE CHAMPIONS LLC @ ROD KELLEY ELEMENTARY	FACILITY NUMBER: 434415372
	VISIT DATE: 11/06/2019

NARRATIVE

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-------------------------continuation of 809 dated 11/06/2019 page 1----------------------------------

The facility does snacks to the children in care. Menu was posted. Area to prepare snacks were observed to be clean. LPA discussed with Site Director about checking the expiration date on food and milk. Drinking water is provided through water cooler and cups.

5 children's files were reviewed during today's inspection. The records reviewed include but not limited to admission agreement and parent's rights.

3 staff files were reviewed during today's inspection. The records reviewed include but not limited to immunization records and Mandated Reporter Training. LPA reminded Site Director to have a copy of Mandated Reporter Training on file. There at least one staff on site with a valid CPR/1st Aid, which expires on 02/2021. All staff present during today's inspection have cleared criminal record clearance and child abuse index clearance.

Site Director stated that she does not have any children in care who require Incidental Medical Services.

In the areas that were evaluated, no deficiencies were cited. An exit interview was conducted where this report was discussed and provided to Site Director Gloria Castro. A notice of site visit has been issued and must be posted for 30 consecutive days.

SUPERVISOR'S NAME: Anthony Studebaker	TELEPHONE: (408) 324-2148
LICENSING EVALUATOR NAME: Samantha Yip	TELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:	DATE: 11/06/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2019

LIC809 (FAS) - (06/04)

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