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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334819673
Report Date: 04/23/2024
Date Signed: 04/23/2024 10:07:33 AM

Document Has Been Signed on 04/23/2024 10:07 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
INLAND EMPIRE CHILD, 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 AVETELEPHONE:
(951) 640-5943
CITY:RIVERSIDESTATE: CAZIP CODE:
92508
CAPACITY: 45TOTAL ENROLLED CHILDREN: 56CENSUS: 15DATE:
04/23/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
07:15 AM
MET WITH:Kimberly Banks, Site DirectorTIME VISIT/
INSPECTION COMPLETED:
10:15 AM
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On 04/23/2024 Licensing Program Analyst (LPA) Susan Brewer, arrived unannounced for the purpose of conducting a case management inspection to verify Plans of Corrections, for citations issued during an annual inspection on 04/04/2023. LPA was greeted and granted entry into the facility. The following was discussed. Present were 2 staff and 15 children in care.

The citations issued below were verified and cleared as of today's date.
1. Type A, CCR 101238(g) Buildings and Grounds, Due 04/05/2024: Poisons, toxins, cleaning solutions were made inaccessible to children. LIC9224 forms were verified in children's file as required.
2. Type A, HSC 1596.871(c)(1)(A) Administration of Child Day Care Licensing, Due 04/05/2024. The director is verified to have a criminal record clearance and associated to the facility.
3. Type B, CCR 101174(d)(2) Disaster and Mass Casualty Plan, Due 04/10/2024: Last fire drill 03/05/2024.
4. Type B, HSC 1596.7995(a)(1) General Provisions and Definitions- Immunization records, Due 04/10/2024 were submitted on 04/09/2024 via e-mail. Missing vaccination for influenza. The director submitted documentation during in inspection for Influenza.
The director requested more time to complete the corrections for Type B citations, listed below. The due date has been extended to 05/08/2024 to submit proof of corrections. Still pending:
5. Type B, CCR 101239(h) Fixtures, Furniture, Equipment and Supplies Due date 04/10/2024: Written Plan, LIC999 Facility sketches updated with the designation of staff restroom and children's restrooms.
6. Type B, HSC 1596.8662(b)(1) Administration of Child Day Care Licensing due 04/19/2024: renewal mandated reporter training.
7. Type B, CCR 101216.1(c)(1) Teacher Qualifications and Duties, due 04/10/2024 for staff and director's packet.
No citations issued on today's date. No civil penalties were issued on today's date.
LPA conducted an exit interview, reviewed the report and left a copy with the Site Director Kimberly Banks.
A notice of cite visit was issued and must remain posted for 30 days.
SUPERVISORS NAME: Kimberly Williams
LICENSING EVALUATOR NAME: Susan Brewer
LICENSING EVALUATOR SIGNATURE: DATE: 04/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/23/2024
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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