<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 434415372
Report Date: 09/28/2022
Date Signed: 09/29/2022 08:47:28 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/21/2022 and conducted by Evaluator Samantha Yip
PUBLIC
COMPLAINT CONTROL NUMBER: 07-CC-20220721133831
FACILITY NAME:KCE CHAMPIONS LLC @ ROD KELLEY ELEMENTARYFACILITY NUMBER:
434415372
ADMINISTRATOR:HELEN DE LA CRUZFACILITY TYPE:
840
ADDRESS:8755 KERN AVENUETELEPHONE:
(408) 707-9381
CITY:GILROYSTATE: CAZIP CODE:
95020
CAPACITY:64CENSUS: 21DATE:
09/28/2022
UNANNOUNCEDTIME BEGAN:
01:05 PM
MET WITH:Gloria CastroTIME COMPLETED:
02:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not prevent day care children from having access to hazardous item
Staff yell at day care children
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Samantha Yip conducted an unannounced complaint investigation the above allegations. LPA met with Site Director Gloria Castro and explained the reason for the inspection.

During the course of this investigation, LPA inspected the physical plant and reviewed revelant documents. LPA also interviewed stafff, children, and third party. Based on the information obtained, the above allegations are found to be SUBSTANTIATED, meaning the allegations are valid because the preponderance of the evidence standard has been met.
-------------------continues on 9099 dated 09/28/2022 page 2--------------------------
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Joel SeguraTELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Samantha YipTELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:

DATE: 09/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 5
Control Number 07-CC-20220721133831
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: 09/28/2022
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
26
27
28
29
30
31
32
----------------continuation of 9099 dated 09/28/2022 page 1--------------------

Based on the interviews and observation, staff did not prevent day care children from having access to hazardous item. Facility gave children party snaps. Party snaps states "To use under close adult supervision. For outdoor use only. Do not put in mouth." It also states consumer fireworks on the side of the box. LPA observed that there was box, which contained the party snaps inside of it. Site Director stated that they have removed the party snaps as a prize for the children and made sure that toys are age appropriate and there is nothing hazardous to them.

Based on the interviews, staff do yell at the children. LPA discussed with Site Director that children's personal rights cannot be violated. Director will conduct training with staff about discipline policy and children's personal rights.

As a result of this investigation, two Type B citations were issued. Exit interview conducted and report was reviewed with Site Director Gloria Castro. A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISOR'S NAME: Joel SeguraTELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Samantha YipTELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:

DATE: 09/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 07-CC-20220721133831
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/28/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/07/2022
Section Cited
CCR
101223(a)(3)
1
2
3
4
5
6
7
The licensee shall ensure that each child is accorded the following personal rights:
To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse or other actions of a punitive nature including but not limited to: interference with functions of daily living including eating, sleeping or toileting; or withholding of shelter, clothing, medication or aids to physical functioning.
This requirement is not met as evident by:
1
2
3
4
5
6
7
By POC 10/07/2022, Site Director will conduct training with staff regarding discipline policy and personal rights. Director will send proof of
8
9
10
11
12
13
14
Based on interviews, staff yell at children in care, which poses a potential health and safety risk to children in care.
8
9
10
11
12
13
14
training and the list of staff who attend the training to Licensing.
Type B
10/07/2022
Section Cited
CCR
101239(m)
1
2
3
4
5
6
7
All play equipment and materials used by children shall be age-appropriate.
This requirement is not met as evident by:
1
2
3
4
5
6
7
Site Director removed party snaps as a prize for children.

By 10/07/2022, Site Director will send statement that all
8
9
10
11
12
13
14
Based on interview and observation, staff gave children party snaps, which poses a potential health and safety risk to children in care.
8
9
10
11
12
13
14
toys given to children are not hazardous to children.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Joel SeguraTELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Samantha YipTELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:

DATE: 09/28/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2022
LIC9099 (FAS) - (06/04)
Page: 5 of 5