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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334841007
Report Date: 03/12/2025
Date Signed: 03/12/2025 03:09:15 PM

Document Has Been Signed on 03/12/2025 03:09 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:		IRIS MEZAFACILITY TYPE:
840
ADDRESS:16940 KRAMERIA AVENUETELEPHONE:
(951) 780-1215
CITY:RIVERSIDESTATE: CAZIP CODE:
92504
CAPACITY: 35TOTAL ENROLLED CHILDREN: 35CENSUS: 22DATE:
03/12/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:00 PM
MET WITH:Iris MezaTIME VISIT/
INSPECTION COMPLETED:
03:15 PM
NARRATIVE
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A case management visit is being conducted in response to the receipt of an unusual incident report (UIR) from the facility. The UIR was received by the licensing agency on 02/27/25 and indicates facility was out of ratio on 02/25/25 from 7:15 AM to 7:30AM. LPA was greeted and granted entry by Site Director, Iris Meza. A census was conducted of 18 children present and supervised by two staff.
Facility records were reviewed, and interview conducted with Site Director. Based on the information gathered, the following violations have been identified: CCR 101516.5(b)(1) Teacher-Child Ratio
(1) A teacher shall supervise no more than 14 children or with an aide a maximum of 28 children.
See LIC809D for cited deficiency of the California Code of Regulations, Title 22, Div. 12. This is a repeat penalty a civil penalty has been issued in the amount of $250.00.
IF a Civil Penalty has been assessed during this inspection. Payment is due when billed and the check(s) or money orders shall be made payable to the “California Department of Social Services”. YOU WILL RECEIVE AN INVOICE IN THE MAIL. DO NOT SEND MONEY UNTIL YOU RECEIVE YOUR INVOICE. DO NOT SEND CASH.
LPA Carbullido informed facility representative Iris Meza that this report dated 03/12/25 document(s) one Type A citation(s) which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care.
Also, LPA Carbullido informed the facility representative Iris Meza to provide a copy of this licensing report dated 03/12/25 that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.
An exit interview was conducted, appeal rights discussed, and a copy of this report and notice of site visit were provided to Site Director, Iris Meza.
SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Giselle Carbullido
LICENSING EVALUATOR SIGNATURE: DATE: 03/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/12/2025
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 03/12/2025 03:09 PM - It Cannot Be Edited


Created By: Giselle Carbullido On 03/12/2025 at 02:24 PM
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 @ WOODCREST ELEMENTARY SCHOOL
FACILITY NUMBER: 334841007

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/12/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/13/2025
Section Cited
CCR
101516.5(b)(1)

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101516.5(b)(1): Teacher-Child Ratio- (1) A teacher shall supervise no more than 14 children or with an aide a maximum of 28 children. This requirement is not met as evidenced by:
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The facility agrees to create a plan to ensure staffing ratio in that a teacher shall supervise no more than 14 children by POC due date of 03/13/25.
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Based on the agency's self - reported Unusual Incident report on 02/27/2025 and interview- facility staff was left to supervise 18 children alone, from 7:15AM- 7:30AM - This is an immediate health & safety risk to children in care. This is a repeat violation.
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A civil penalty has been issued in the amount of $250.00.

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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:Gilbert Sena
LICENSING EVALUATOR NAME:Giselle Carbullido
LICENSING EVALUATOR SIGNATURE:
DATE: 03/12/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/12/2025


LIC809 (FAS) - (06/04)
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