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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343624351
Report Date: 01/11/2024
Date Signed: 01/11/2024 12:48:40 PM


Document Has Been Signed on 01/11/2024 12:48 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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827



FACILITY NAME:KCE CHAMPIONS LLC @ CRESFACILITY NUMBER:
343624351
ADMINISTRATOR:AMY DODGEFACILITY TYPE:
850
ADDRESS:13580 JACKSON ROADTELEPHONE:
(530) 391-6816
CITY:SLOUGHOUSESTATE: CAZIP CODE:
95683
CAPACITY:15CENSUS: 7DATE:
01/11/2024
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Camille GordonTIME COMPLETED:
01:00 PM
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On Thursday, January 11, 2024, Licensing Program Analyst (LPA) Amanda Sutter met Facility representative Camille Gordon for the purpose of an unannounced required annual inspection. LPA observed 7 children supervised by two staff. All individuals subject to criminal background review have obtained a criminal record clearance. The facility hours of operation are Monday through Friday from 7:30 AM to 5:00 PM.

LPA toured classroom space, restrooms, and outdoor play area. LPA observed the following documents are posted: License, Child personal Rights, Seat Belt Law, Menu, Daily Schedule, and Emergency Disaster Plan. Cleaning disinfectants and hazardous items are appropriately stored and inaccessible to children. Facility representative stated there are no poisons or firearms on the premises. Furniture and equipment are in good condition, and toileting facilities are in safe, sanitary, and operating condition. The provides AM and PM snack.

LPA observed trash bins with tight fitted lids. The facility uses a paper sign in and out system. Facility has record of conducting fire drills at least every six months. The last fire drill was conducted on December 12, 2023. In accordance with manufacturer guidelines, the Facility representative stated that the program does not use the play structure in the play area. Children play with toys on the grass and paved areas. There are sufficient equipment and toys, and shaded areas are supplied by building awnings. Drinking water is readily available to children both indoors and outdoors. The facility orders filtered water jugs and children bring their own water bottles from home.

Two staff and three children's records were reviewed. Both children’s files and staff files were observed to be complete. There is at least one staff member present with a current CPR certificate.

PAGE 1. REPORT CONTINUES ON LIC809-C

SUPERVISOR'S NAME: Seychelle De LucaTELEPHONE: (916) 263-5719
LICENSING EVALUATOR NAME: Amanda SutterTELEPHONE: (916) 261-8918
LICENSING EVALUATOR SIGNATURE:
DATE: 01/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/11/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: KCE CHAMPIONS LLC @ CRES
FACILITY NUMBER: 343624351
VISIT DATE: 01/11/2024
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LPA discussed the safe sleep regulations with facility representative and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also facility representative of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

LPA provided facility representative with the Department website for lead: https://www.cdss.ca.gov/inforesources/child-care-licensing/water-testing-information

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of “medication and equipment/supplies, and reviewed children’s, personnel, and administrative records.

For IMS information see PIN 22-02-CCP. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514-0383 (TTY) and link to publication. Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/.

Facility representative was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

Facility representative was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

During today’s inspection, no deficiencies were observed. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with Facility representative Camille Gordon. Appeal rights were provided.
SUPERVISOR'S NAME: Seychelle De LucaTELEPHONE: (916) 263-5719
LICENSING EVALUATOR NAME: Amanda SutterTELEPHONE: (916) 261-8918
LICENSING EVALUATOR SIGNATURE:

DATE: 01/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/11/2024
LIC809 (FAS) - (06/04)
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