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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343624352
Report Date: 07/18/2024
Date Signed: 07/18/2024 10:29:06 AM

Document Has Been Signed on 07/18/2024 10:29 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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:KCE CHAMPIONS LLC @ CRESFACILITY NUMBER:
343624352
ADMINISTRATOR:AMY DODGEFACILITY TYPE:
840
ADDRESS:13580 JACKSON ROADTELEPHONE:
(530) 391-6816
CITY:SLOUGHOUSESTATE: CAZIP CODE:
95683
CAPACITY: 48TOTAL ENROLLED CHILDREN: 48CENSUS: 9DATE:
07/18/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Camille UtterbackTIME COMPLETED:
10:45 AM
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On Thursday, July 17, 2024, Licensing Program Analyst (LPA) Amanda Sutter met with Lead Teacher Camille Utterback for the purpose of an unannounced required annual inspection. Upon arrival, LPA observed nine children supervised by three staff. All individuals subject to criminal background review have obtained a criminal record clearance. During school breaks, the facility hours of operation are Monday through Friday, 8:00 AM to 5:00 PM. A separate School Age program that is exempt from licensure operates in the same classroom during the school year and summer school.

LPA toured classroom space and outdoor play area. LPA observed the following documents are posted: License, Parents' Rights Poster, Child Personal Rights, Menu, Daily Schedule, and Emergency Disaster Plan. LPA observed a functional carbon monoxide detector and full 2A10BC fire extinguisher. Cleaning disinfectants and hazardous items are appropriately stored and inaccessible to children. Lead Teacher 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. The last fire drill was conducted on July 15, 2024. The program has been operating since 7/17/2024 and during spring break. Lead Teacher stated that the facility has not conducted a fire drill during this time, but that many of the same children that attended the previous School Age program are attending KCE Champions @ CRES. Playground equipment and surfaces are free of loose or sharp parts, and bark is present under the equipment to provide sufficient cushioning. There is sufficient equipment and toys, and shaded areas are supplied by the building and trees. Drinking water is readily available to children both indoors and outdoors. Lead Teacher stated that children use water bottles which are filled using water jugs.

Three staff and four 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. Facility roster was observed. PAGE 1. REPORT CONTINUES ON LIC809-C

SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Amanda Sutter
LICENSING EVALUATOR SIGNATURE: DATE: 07/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/18/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
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: 343624352
VISIT DATE: 07/18/2024
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LPA referred facility representative to the Department website for lead: https://www.cdss.ca.gov/inforesources/child-care-licensing/water-testing-information

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 informed 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.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02- CCP. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. 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 Lead Teacher Camille Utterback. Appeal rights were provided.

SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Amanda Sutter
LICENSING EVALUATOR SIGNATURE:

DATE: 07/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2024
LIC809 (FAS) - (06/04)
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