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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 344501195
Report Date: 08/19/2024
Date Signed: 08/19/2024 03:14:52 PM

Document Has Been Signed on 08/19/2024 03:14 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 S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:KCE CHAMPIONS LLC @ ARCOHEFACILITY NUMBER:
344501195
ADMINISTRATOR/
DIRECTOR:		FULTZ, SANDYFACILITY TYPE:
860
ADDRESS:11755 IVIE ROADTELEPHONE:
(916) 833-7982
CITY:HERALDSTATE: CAZIP CODE:
95638
CAPACITY: 60TOTAL ENROLLED CHILDREN: 60CENSUS: 0DATE:
08/19/2024
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:45 AM
MET WITH:Sandy FultzTIME VISIT/
INSPECTION COMPLETED:
11:15 AM
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Centralized Application Bureau (CAB) Licensing Program Analyst (LPA) Alecia Sifuentes and met with Area Manager Sandy Fultz and Site Director Megan Kirwin for the purpose of a pre-licensing inspection. Licensee requests a school-age license to serve 60 school-age children enrolled in kindergarten and above. The program will operate Monday through Friday from 7:00 a.m. to 6:00 p.m. The fire clearance (STD850) was granted and received on 8/13/2024. A letter from the Arcohe Union School District Superintendent is on file allowing the program to utilize room A19 and the multipurpose room for the capacity requested.

The facility will be providing morning and afternoon snacks. Parents will provide lunches during holidays, breaks, and summer. LPA reviewed with Site Director the LIC 311A, Records To Be Maintained At The Facility, for child’s records, personnel records, administrative records, and documents to be posted.

INDOOR ACTIVITY SPACE:

There is one school-age classroom located in Room A19. The school-age children will also be utilizing the Multipurpose Room (MPR). LPA observed a sufficient amount of equipment, tables, chairs, and shelves. Medications will be stored in the teacher's cabinet. First aid kit is located in the front door and on the high cabinet. LPA observed cleaning disinfectants are appropriately stored and inaccessible to children. Site Director stated there are no poisons or firearms on the premises. LPA observed one water fountain outside of the classroom that children will use to refill their water bottles throughout the day. LPA observed a dual smoke and carbon monoxide detector in the classroom. LPA observed a sign-in/sign-out binder.

Report continues on LIC809-C page 2.

SUPERVISORS NAME: Mai Lor
LICENSING EVALUATOR NAME: Alecia Sifuentes
LICENSING EVALUATOR SIGNATURE: DATE: 08/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/19/2024
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 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: KCE CHAMPIONS LLC @ ARCOHE
FACILITY NUMBER: 344501195
VISIT DATE: 08/19/2024
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Licensee has requested a capacity of 60 school-age children. Per Health and Safety Code 1596.806, the facility is exempt from square footage requirement; therefore, LPA did not take measurements. The children will use the school’s restrooms, and a separate private restroom for the staff located near the MPR. Children who become ill during the day will be isolated in the office area of the classroom and will use the staff restroom, if necessary.

OUTDOOR ACTIVITY SPACE:

There is one outdoor area on the property. The outdoor play area is fenced with a chain link fence that is at least four feet tall. LPA observed a sufficient amount of equipment and toys. There are no bodies of water on the premises. There are shaded areas supplied by overhangs and trees. Per Health and Safety Code 1596.806, the facility is exempt from square footage requirement; therefore, LPA did not take measurements.

This facility plans to provide Incidental Medical Services – IMS. For IMS information, see PIN 22-02-CCP. A 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, available at: http://www.ada.gov/childqanda.htm

LPA discussed the following: supervision; personal rights; inspection authority; reporting requirements; staff to children ratios and capacity; staff qualifications; and maintaining buildings and grounds. LPA discussed with Site Director any changes that may occur regarding the director or an employee acting in the director's absence must be reported to department within 10 working days.

Report continues on LIC809-C page 3.

SUPERVISORS NAME: Mai Lor
LICENSING EVALUATOR NAME: Alecia Sifuentes
LICENSING EVALUATOR SIGNATURE:

DATE: 08/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2024
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 S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: KCE CHAMPIONS LLC @ ARCOHE
FACILITY NUMBER: 344501195
VISIT DATE: 08/19/2024
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Site Director was reminded that all adults 18 and over responsible for administration or direct supervision of staff, persons who provides care and supervision to children, and staff who have contact with children, 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.

Site Director was informed of the MyChildCarePlan.org site, 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.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform. To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

Exit interview conducted and report was reviewed with Area Manager Sandy Fultz.

Effective today, 8/19/2024, LPA will approve the facility for 60 school-age children enrolled in kindergarten and above in Rooms A19 and MPR.

SUPERVISORS NAME: Mai Lor
LICENSING EVALUATOR NAME: Alecia Sifuentes
LICENSING EVALUATOR SIGNATURE:

DATE: 08/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2024
LIC809 (FAS) - (06/04)
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