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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334841007
Report Date: 10/02/2024
Date Signed: 10/02/2024 02:32:47 PM

Document Has Been Signed on 10/02/2024 02:32 PM - 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 @ WOODCREST ELEMENTARY SCHOOLFACILITY NUMBER:
334841007
ADMINISTRATOR/
DIRECTOR:		CAMMIE DONAGHYFACILITY TYPE:
840
ADDRESS:16940 KRAMERIA AVENUETELEPHONE:
(951) 780-1215
CITY:RIVERSIDESTATE: CAZIP CODE:
92504
CAPACITY: 35TOTAL ENROLLED CHILDREN: 35CENSUS: 18DATE:
10/02/2024
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:35 PM
MET WITH:Marie Milner/Cammie DonaghyTIME VISIT/
INSPECTION COMPLETED:
02:40 PM
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A case management visit is being conducted in response to notification that the school age program is unable to use portable 19 due to a sink leak/repairs and subsequent mold testing /assessment from 10/3/24-10/13/24. LPA was greeted and granted entry by Site Director, Cammie Donaghy and Interim Area Manager, Marie Milner. Per Area Manager, portable 19 will be closed temporarily and there is no additional space at the public-school site -Woodcrest Elementary.
The school age program days and hours of operation are Monday through Friday 6:00AM – 8:10AM and 1:20PM - 6:00PM in room #19.
During today’s visit, Area Manager notified LPA that KCE Champions has opted to use alternate sister sites until repairs and clearance for use is obtained for portable 19. Other sites are at fully functioning public school sites. Waivers are not needed as the program operates before and after-school, in-service days and during school holidays only.
Per Health and Safety code Section 1596.806. This program is exempt from square footage requirements and toilet and sink requirements, fencing outdoor activity requirements, and isolation area requirement as the program is operated on a functioning school site which has been approved for public accommodation and instruction.
Area Manager submitted written statement that staff and children records shall be complete and available for review – irrespective of staff or children’s rotations to other sites and/or for staff coverage and that operation of other sites will be in accordance with scope of licensed capacity. Area Manager agrees to submit clearance inspection report for portable 19 to the department for review prior to resuming use at Woodcrest Elementary program site.
An exit interview was conducted, and LPA Carbullido provided Area Manager, Marie Milner with a copy of this report, appeal rights and notice of site visit during today’s visit.
SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Giselle Carbullido
LICENSING EVALUATOR SIGNATURE: DATE: 10/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/02/2024
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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