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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 334842893
Report Date: 10/06/2022
Date Signed: 10/06/2022 03:02:37 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/14/2022 and conducted by Evaluator Giselle Carbullido
PUBLIC
COMPLAINT CONTROL NUMBER: 09-CC-20220914135945
FACILITY NAME:KCE CHAMPIONS LLC @ TAFT ELEMENTARY SCHOOLFACILITY NUMBER:
334842893
ADMINISTRATOR:RONYA GOUMMAFACILITY TYPE:
840
ADDRESS:959 MISSION GROVE PARKWAY N.TELEPHONE:
(951) 312-4094
CITY:RIVERSIDESTATE: CAZIP CODE:
92506
CAPACITY:50CENSUS: 23DATE:
10/06/2022
UNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Ronya GoumaaTIME COMPLETED:
03:15 PM
ALLEGATION(S):
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Lack of supervision resulted in an inappropriate interaction between children.
INVESTIGATION FINDINGS:
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On the date and time listed above, Licensing Program Analyst (LPA) Giselle Carbullido arrived at the facility to conduct an investigation regarding the above complaint received on 09/14/2022. Facility self-reported incident on 09/06/22 which resulted in a case-management visit on 09/13/22. An initial visit was conducted on 09/16/22, which LPA conducted staff/children interviews and reviewed records.
On today’s visit, LPA was given access to the facility by Ronya Goumaa, Director. LPA discussed purpose of visit, took census and toured the facility. LPA met with the Ms. Goumaa to further discuss the complaint allegations and deliver findings.
Lack of supervision resulted in an inappropriate interaction between children: It was alleged a child attempted to kiss and then touch another child in their private area.
LPA interviewed all pertinent parties involved, including staff and children. There was conflicting information whether the touching was intentional or accidental. Staff stated they were present; however, the incident occurred so quickly, they couldn’t prevent. Staff stated due to the low census, ratio is maintained at 1:14 (staff to children), or better, and personal space boundaries (bubble) are regularly reviewed with children in care.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Giselle Carbullido
LICENSING EVALUATOR SIGNATURE:

DATE: 10/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 09-CC-20220914135945
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: KCE CHAMPIONS LLC @ TAFT ELEMENTARY SCHOOL
FACILITY NUMBER: 334842893
VISIT DATE: 10/06/2022
NARRATIVE
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Due to conflicting information from interviews conducted and what was reported, the LPA is unable to determine if a lack of supervision resulted in an inappropriate interaction between children; therefore, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.
An exit interview was conducted, and LPA Carbullido provided Ronya Goumaa Director with a copy of this report, appeal rights and notice of site visit. This report must be made available to the public upon request for three years.
SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Giselle Carbullido
LICENSING EVALUATOR SIGNATURE:

DATE: 10/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2