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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 367750005
Report Date: 10/22/2024
Date Signed: 10/22/2024 04:01:13 PM

Document Has Been Signed on 10/22/2024 04:01 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
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:KCE CHAMPIONS LLC @ WEST PALMSFACILITY NUMBER:
367750005
ADMINISTRATOR/
DIRECTOR:		MURRAY, KEITHFACILITY TYPE:
840
ADDRESS:14375 DEL GADO RDTELEPHONE:
(760) 694-5036
CITY:VICTORVILLESTATE: CAZIP CODE:
92392
CAPACITY: 30TOTAL ENROLLED CHILDREN: 30CENSUS: 28DATE:
10/22/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:26 PM
MET WITH:Rosa WheelerTIME VISIT/
INSPECTION COMPLETED:
04:00 PM
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On October 22, 2024, Licensing Program Analyst (LPA) Calloway made an unannounced inspection to the above facility for the purpose of conducting a Required Annual Random inspection. LPA met with facility representative who granted access. LPA and representative toured the facility inside and outside. LPA observed twenty-eight (28) children in active play and one site supervisor and two representatives. The facility operates in the morning from 6:00 am to 7:30 AM and afternoons 2:00-6:30 PM. Monday through Friday. With the exception, on Friday afternoons the hours are 11:55-6:30 PM. Care age group is Kindergarten to Sixth grade.
Physical Plant: Daycare is provided in Project Room #B. LPA observed one clean and safe classroom that is a shared classroom with the school and transformed daily to the daycare room. There is proper telephone service, heating, lighting, and ventilation that are adequate. There are plastic baskets for children's belongings inside the classroom. Furniture, books, equipment, toys, and materials were age appropriate. Drinking water is available inside the classrooms in the form of a drinking fountain. Per representative, there is no napping. The classroom has a first aid backpack which is hanging in the classroom on the wall near the front door. Medicines are locked inside the front cabinet in a locked container. There was not an Emergency Survival Kit Bin observed. The smoke detector and carbon monoxide detector are not tested. Per representative the last fire inspection was conducted through the school. LPA observed a sprinkler system inside the ceiling.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Kuliema Calloway
LICENSING EVALUATOR SIGNATURE: DATE: 10/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/22/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: KCE CHAMPIONS LLC @ WEST PALMS
FACILITY NUMBER: 367750005
VISIT DATE: 10/22/2024
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Trash cans have secure lids. There is a sink, microwave, and handwashing sink inside the classroom. There are seventeen cabinets that are locked and a small refrigerator that has a padlock. There were enough tables and chairs for all children. There is a fire alarm on the wall, but no pull switch inside the classroom. LPA did not observe a fire extinguisher inside the classroom. There are two-way radios for communication. The doorways have visible exit signs. LPA observed all age groups comingling together inside the classroom without separation at the tables.

Bathrooms: LPA inspected the children's bathroom. There are two separate bathrooms down the hall on the right for the Boys: there were two toilet stalls, one urinal, and two sinks. The Girls: has two sinks and two toilet stalls all were functioning properly and age appropriate there were no hazards. In both restrooms, LPA observed soap, toilet paper, and paper towels readily available. Staff restrooms are inside the teachers’ lounge and separate from the children. There are alternate bathrooms inside the cafeteria that are for use the Boys: has two toilet stalls, two sinks, and two urinals the Girls: has three toilet stalls and two sinks.


Kitchen: The kitchen is not used by the daycare program. Snacks are provided inside the classroom. Menus were posted. LPA did not observe an allergy list posted in each classroom. Per representative, it is inside the cabinet. LPA observed an appropriate amount of food and snacks. The chemicals are kept separate from the food. Cleaning supplies are kept in a locked cabinet at the front of the classroom.
Outside: Outdoor play equipment was inspected for health, safety, cushioning material, good repair and is age appropriate. LPA observed a large play structure with two slides at the front of the school. There was no shade provided and a cushioned rubber surface that is securely anchored.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Kuliema Calloway
LICENSING EVALUATOR SIGNATURE:

DATE: 10/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2024
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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
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: KCE CHAMPIONS LLC @ WEST PALMS
FACILITY NUMBER: 367750005
VISIT DATE: 10/22/2024
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The playground was observed to be free of debris. Drinking water is available in the form of a water cooler and disposable cups. There are no bodies of water on the premises. There is a small grass area to the north of the classroom that is also used for playtime.
Other: Children and staff files were reviewed. Current Pediatric CPR and First Aid Exp: 9/2026; Transportation is not provided. Disaster Drills: Fire and Earthquake both drills were conducted on 8/29/24. The Child/Parent Roster is incomplete and missing the physician’s names and phone numbers for all children. Children are inspected for illnesses as they arrive. There is a separate area for isolation and care of ill children against the wall on a mat until the parent can pick up the child. Staff/child ratios were observed- compliant, sign in/out sheets were face to name. Facility representative was reminded to access the Licensing website at www.ccld.ca.gov. to obtain information about the most recent regulatory changes and the Quarterly Updates. A review of medication policy indicated that prescription medication is administered only with parent's written permission. The management staff administers medication and documents the dosage, date, and time onto a log. Medication is brought and taken home by the parents daily or stored in the locked cabinet. Medication is properly labeled and stored in its original container. 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. State law prohibits baby walkers, bouncy seats, exersaucers, or any other items that fall into that category.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Kuliema Calloway
LICENSING EVALUATOR SIGNATURE:

DATE: 10/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2024
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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
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: KCE CHAMPIONS LLC @ WEST PALMS
FACILITY NUMBER: 367750005
VISIT DATE: 10/22/2024
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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/.

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care
Centers (CCCs) constructed before January 1, 2010, to test their water (used for
drinking and food preparation) for lead contamination before January 1, 2023, and then every 5 years after the date of the first test. For childcare center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1-CCP). Or LPA referred facility representative to the Department website for lead: Lead Toxicity Prevention and Water Testing Information. Lead Poisoning: For more information, go to the California Childhood Lead Poisoning Prevention Branch’s website at www.cdph.ca.gov/programs/clppb,or call them at (510) 620-5600. Per representative, the water lead test was conducted in September 2024.

Facility representative was informed of the MyChildCarePlan.org website, a
consumer education website that helps families obtain childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Kuliema Calloway
LICENSING EVALUATOR SIGNATURE:

DATE: 10/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2024
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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
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: KCE CHAMPIONS LLC @ WEST PALMS
FACILITY NUMBER: 367750005
VISIT DATE: 10/22/2024
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To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at:
www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.
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 platforms. To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at subscribe and select the Childcare option to receive email communication. https://www.cdss.ca.gov/inforesources/community-carelicensing/

The On Duty Worker is available for questions Monday through Friday at (661) 202-3318 from 8:00 AM - 5:00 PM for questions, information, and Unusual Incident Reporting.

Per Title 22 Regulations, Division 12, Chapter 1, there are deficiencies cited during this inspection. See 809D pages.

Exit interview was conducted and a copy of this report was read, a Notice of Site Visit, this report, and Appeal Rights were provided to Rosa Wheeler, Facility Representative. A Notice of Site Visit must remain posted for thirty (30) consecutive days. Failure to maintain posting will result in a $100 civil penalty.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Kuliema Calloway
LICENSING EVALUATOR SIGNATURE:

DATE: 10/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 10/22/2024 04:01 PM - It Cannot Be Edited


Created By: Kuliema Calloway On 10/22/2024 at 03:53 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
, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: KCE CHAMPIONS LLC @ WEST PALMS
FACILITY NUMBER: 367750005

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/22/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.7995(a)(1)
General Provisions and Definitions
(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, and record review, the licensee did not comply with the section cited above in one of out of three staff did not have their immunization records (S3) which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/12/2024
Plan of Correction
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I will provide proof to Licensing by POC date of 11/12/24
Type B
Section Cited
CCR
101515(b)
School-Age Child Care Center Director Qualifications and Duties
(b) All school-age child care centers shall have a director.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, and record review the licensee did not comply with the section cited above in the new center site supervior was not reported to Licensing which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/19/2024
Plan of Correction
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I will provide proof to Licensing by POC date
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:Claretta Yates
LICENSING EVALUATOR NAME:Kuliema Calloway
LICENSING EVALUATOR SIGNATURE:
DATE: 10/22/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/22/2024


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