313623695-7-19-2021-03-CC-KOWS-C53P4R-20210719105936

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 313623695
Report Date: 07/19/2021
Date Signed: 07/19/2021 10:59:47 AM

Document Has Been Signed on 07/19/2021 10:59 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME:	KCE CHAMPIONS LLC @ RIEGO CREEK		FACILITY NUMBER:	313623695
ADMINISTRATOR:	FISCHER, ANNIE		FACILITY TYPE:	840
ADDRESS:	3255 PRUETT DRIVE		TELEPHONE:	(916) 792-1840
CITY:	ROSEVILLE	STATE: CA	ZIP CODE:	95747
CAPACITY: 60	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	07/19/2021
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Amy Dodge -		TIME COMPLETED:	11:00 AM

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 Owens met with Area Manager, Amy Dodge, for the purpose of an announced Case Management inspection. The facility requests a change of classrooms from LC2.4 and LC2.5 to now using classrooms LC2.6 and LC2.7 (no capacity change). They have a school-age license to serve 60 school-age children enrolled in kindergarten and above. The program will operate Monday through Friday from 7:00 AM to 5:30 PM at the Riego Creek Elementary School. LPA Owens received the elementary school fire clearance on 7/18/2021. The Area Manager, Amy Dodge acknowledge that the following documents must be posted at all times: License, Emergency Disaster Plan, Personal Rights, Parents' Rights Poster, and daily schedule. LPA discussed the forms that must be in each child's and each staff member's file. The facility will be providing snacks. INDOOR ACTIVITY SPACE: LPA observed classrooms LC2.6 and LC2.7, the classroom were not set up at time of inspection. There is sufficient storage for children belongings. There is a first aid kit in the classroom. Medications will be stored in the classroom in a locked cabinet. Cleaning disinfectants are appropriately stored and inaccessible to children. Area Manager stated there are no poisons or firearms on the premises. There are water fountains located in the classrooms, and they will also be using cups and igloos for indoor water. LPA observed a functional carbon monoxide detector. Area Manager stated a paper sign-in/sign-out system will be used. Report continues on 809-C

SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Katrina Owens
LICENSING EVALUATOR SIGNATURE:	DATE: 07/19/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2021

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, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME: KCE CHAMPIONS LLC @ RIEGO CREEK	FACILITY NUMBER: 313623695
	VISIT DATE: 07/19/2021

NARRATIVE

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Per Health and Safety Code 1596.806, the facility is exempt from square footage and toilet requirements; therefore, LPA did not take measurements. The children will use the school’s restrooms, and there is a separate private restroom for the staff. Children who become ill during the day will be isolated in an area in the classroom and will use the staff restroom, if necessary.

OUTDOOR ACTIVITY SPACE:
There is one outdoor area on the property. There is a climbing structure that the Area Manager stated is anchored into the ground. Area Manager stated there are no bodies of water on the premises. There is a water fountain on the playground for children use.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department.

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.

LPA discussed any changes that may occur regarding the director or an employee acting in the director's absence must be reported to department within 10 working days.

This facility evaluation report was reviewed and discussed with Area Manager and was encouraged to the visit the Department's website at WWW.CDSS.CA.GOV for information regarding child care updates, forms, regulations and legislation pertaining to child care centers.

Report continued on 809 C

SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Katrina Owens
LICENSING EVALUATOR SIGNATURE:	DATE: 07/19/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2021

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, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME: KCE CHAMPIONS LLC @ RIEGO CREEK	FACILITY NUMBER: 313623695
	VISIT DATE: 07/19/2021

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CONDITIONS REQUIRING CORRECTION PRIOR TO ISSUING A LICENSE:
1. Submit photo's of classroom set up with chairs and tables to accommodate 30 children in each classroom.

2. Submit Photos of required licensing forms posted.

3. Submit Photos of garbage can with lid for each classroom.

4. Submit Photo of sign in/out station area set up.

5. A final review of the file by Licensing Program Manager (LPM) Keven Peters.

SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Katrina Owens
LICENSING EVALUATOR SIGNATURE:	DATE: 07/19/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2021

LIC809 (FAS) - (06/04)

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