434415375-10-23-2019-07-CC-SYIP-BH8VVH-20191023164619

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434415375
Report Date: 10/23/2019
Date Signed: 10/23/2019 04:46:24 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 @ LUIGI APREA ELEMENTARY		FACILITY NUMBER:	434415375
ADMINISTRATOR:	DE LA CRUZ, HELEN		FACILITY TYPE:	840
ADDRESS:	9225 CALLE DEL REY		TELEPHONE:	(408) 707-9381
CITY:	GILROY	STATE: CA	ZIP CODE:	95020
CAPACITY:	56	CENSUS: 50	DATE:	10/23/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	03:11 PM
MET WITH:	Laura Summers		TIME COMPLETED:	04:50 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 met with Laura Summers, Site Director, and explained the reason for the inspection. Present during the inspection were 4 staff and 50 children. Facility is located on the Luigi Aprea Elementary School campus. LPA reviewed the sign in/sign out sheet. License, Notification of Parent's Right, and Emergency Disaster Plan were observed to be posted. LPA toured the inside and outside of the facility. The facility was observed to be clean. Disinfectants, cleaning supplies, and other items that are dangerous to children in care were observed to be stored inaccessible to children in care. Furniture and equipment, such as tables and chairs, were observed to be in good condition and age appropriate. There is sufficient amount of toys for children in care. LPA observed a fully charged fire extinguisher, smoke detector, and carbon monoxide detector. Director stated that there are no weapons, such as firearms stored on the premise. Facility uses the playground and grass area on elementary school campus. The area is fenced. Play structure were observed to be in good condition. Areas around the play structure have resilient material to absorb falls. LPA discussed with Director about sweeping the playground to ensure resilient material is even. Facility does provides snacks to the children in care. Menu was observed to be posted. Kitchen used to store snacks was observed to be clean and sanitary. Drinking water is provided through water fountains. 10 children's files were reviewed during today's inspection. The records reviewed include but not limited to admission agreement and parent's rights. ---------------------------continues on 809 dated 10/23/2019 page 2---------------------------

SUPERVISOR'S NAME: Anthony Studebaker	TELEPHONE: (408) 324-2148
LICENSING EVALUATOR NAME: Samantha Yip	TELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:	DATE: 10/23/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2019

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 @ LUIGI APREA ELEMENTARY	FACILITY NUMBER: 434415375
	VISIT DATE: 10/23/2019

NARRATIVE

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--------------------continuation of 809 dated 10/23/2019 page 1-------------------------------------
4 staff files were also reviewed during today's inspection. The records reviewed include but not limited to education credit, Mandated Reporter Training, and immunization records for measles and pertussis. There currently at least one staff on site with a valid CPR/1st Aid, which expires on 02/2021.

LPA observed that S-1 was not on facility facility roster printed 10/22/2019. S-1 is fingerprint cleared and associated to other KCE Champion sites. Site Director stated that they submitted the transfer request for S-1 on 10/23/2019 to the San Jose Regional Office. All other staff present during today's inspection have cleared criminal record clearance and child abuse index clearance. LPA reminded Director that any staff working complete LiveScan or submit transfer request. LPA also reminded Director of the applicable civil penalties for those adults who have not received fingerprint clearances, are not associated to the license and who come in contact with or provide care and supervision to the children. Penalty amounts: $100.00 per person per day, minimum of $100.00 to a maximum of $500.00 per person for an initial violation and a minimum of $100.00 to a maximum of $3000.00 per person for any subsequent violation within a 12 month period.

Site Director stated that she currently does not have any children in care who requires Incidental Medical Services (IMS) services. 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.

Site Director is encouraged to visit the Department’s website at www.cdss.ca.gov to access resources for Providers, Title 22 Regulations, Online Licensing Forms, Adoption of new Laws, etc.

No deficiencies were cited as a result of today's inspection. An exit interview was conducted, where this report was discussed and provided to Site Director Laura Summers. A NOTICE OF SITE VISIT WAS ISSUE 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: 10/23/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2019

LIC809 (FAS) - (06/04)

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