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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334819673
Report Date: 11/07/2024
Date Signed: 11/07/2024 11:40:29 AM

Document Has Been Signed on 11/07/2024 11:40 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
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:KCE CHAMPIONS LLC @ MARK TWAIN ELEMENTARY SCHOOLFACILITY NUMBER:
334819673
ADMINISTRATOR/
DIRECTOR:		DEBORAH HILLFACILITY TYPE:
840
ADDRESS:19411 KRAMERIA AVENUETELEPHONE:
(951) 640-5943
CITY:RIVERSIDESTATE: CAZIP CODE:
92508
CAPACITY: 45TOTAL ENROLLED CHILDREN: 49CENSUS: 16DATE:
11/07/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:37 AM
MET WITH:Lead Teacher Leilani OrozcoTIME VISIT/
INSPECTION COMPLETED:
11:45 AM
NARRATIVE
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On the above date and time Licensing Program Analyst (LPA) Susan Brewer and Licensing Program Manager (LPM) Ana Noble arrived at the facility to conduct a case management inspection in response to the receipt of an unusual incident report (UIR) received from the facility. The LPA and LPM were greeted by Lead Teacher Leilani Orozco, and granted entry into the facility. The Director Melody Perez was away from the facility. A census was conducted of 16 children present and supervised by 2 staff.

On 11/05/2024 the licensing agency received a self - reported UIR. It indicated that on 11/04/2024 the facility was operating out of ratio between approximately 7:30 AM and 7:45 AM. In addition, the facility director Melody Perez, attempted to find substitute staffing to assist with supervision for the morning shift however, the director was unable to secure a substitute teacher or teacher assistant. Based on the information reported by the agency on 11/05/2024, the following violation has been identified 101516.5(b)(1) Teacher-Child Ratio.

See LIC809D Type B violation for cited deficiency of the California Code of Regulations, Title 22, Div. 12., 101516.5(b)(1) Teacher-Child Ratio

No civil penalty was issued.

An exit interview was conducted, the report was reviewed, and a copy of the report was provided with Leilani Orozco.

A notice of site visit was issued and must remain posted for 30 days.
SUPERVISORS NAME: Ana Noble
LICENSING EVALUATOR NAME: Susan Brewer
LICENSING EVALUATOR SIGNATURE: DATE: 11/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/07/2024
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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Document Has Been Signed on 11/07/2024 11:40 AM - It Cannot Be Edited


Created By: Susan Brewer On 11/07/2024 at 11:07 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: KCE CHAMPIONS LLC @ MARK TWAIN ELEMENTARY SCHOOL
FACILITY NUMBER: 334819673

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/07/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/14/2024
Section Cited
CCR
101516.5(b)(1)

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101516.5(b)(1) Teacher-Child Ratio
(b) There shall be a staffing ratio of 1 teacher & 1 aide present to every 28 children... (1) A teacher shall supervise no more than 14 children or with an aide a maximum of 28 children. This regulation was not met as evidenced by:

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The facility agrees to create a plan to ensure staffing ratio of 1 teacher & 1 aide present to every 28 children in attendance and a teacher shall supervise no more than 14 children or with an aide a maximum of 28 children.
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Based on the agency's self - reported Unusual Incident, on 11/04/2024 a facility staff was left to supervise 19 children alone, for approximately 15 minutes, 7:30 AM and 7:45 AM, which is a potential risk to the health & safety of children in care.
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The facility also agrees to submit the plan to the department on or before 11/14/2024 for review and approval.

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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:Ana Noble
LICENSING EVALUATOR NAME:Susan Brewer
LICENSING EVALUATOR SIGNATURE:
DATE: 11/07/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/07/2024


LIC809 (FAS) - (06/04)
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