376105060-8-13-2021-51-CC-SCLA-C5UTVV-20210813150435

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 376105060
Report Date: 08/13/2021
Date Signed: 08/13/2021 03:04:43 PM

Document Has Been Signed on 08/13/2021 03:04 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
CCLD Regional Office, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108

FACILITY NAME:	KCE CHAMPIONS LLC AT ELEVATE MIDDLE		FACILITY NUMBER:	376105060
ADMINISTRATOR:	ROBYN CLARK		FACILITY TYPE:	840
ADDRESS:	8404 PHYLLIS PLACE		TELEPHONE:	(619) 746-9178
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92123
CAPACITY: 50	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	08/13/2021
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Robyn Clark		TIME COMPLETED:	03:20 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 08/13/2021 at 1:00pm, Licensing Program Analyst (LPA), Samantha Clenista conducted an announced Pre-Licensing inspection. LPA met with Facility Representative, Robyn Clark (Area Manager) and various Site Directors (from other KCE sites) who were present to shadow the pre-licensing process; Danielle Cabanaugh, Jocelyn Hernandez, Daniel Adams and Jennifer Flaningam. A tour of the facility was conducted. This program will be using rooms 101 and 102 located at City View Church (aka Elevate Middle School). A fire clearance was granted on 08/03/2021. The program will use the bathrooms (girls and boys) located in the hallway that afford privacy. Both classrooms are used as elementary school classrooms during the day. Per Health and Safety Code Sections 1596.806(a), (a)(1), (1)(2) and (d) this program is exempt from square footage, fencing, outdoor activity space, toilet and isolation requirements. Outdoor play areas include open areas behind Classroom 101 & 102, lunch tables/walkway areas, grassy area located right of the campus and gazebo. The rooms are equipped with tables and chairs and age appropriate equipment. However, the chairs and tables are borrowed from upstairs classrooms until their furniture order arrives (by 08/302021). There is a sink available in each room. Drinking water is readily accessible via water bottles and refillable water jugs. Snacks will be provided. They will be prepared in the classroom. There is a refrigerator in classroom 102. Bathrooms and classroom sinks have hot and cold running water. Classrooms have storage space for food. There is an operational carbon monoxide detector in both classrooms. Sign-in area is located in Classroom 102. All COVID-19 posters are posted. COVID-19 self-assessment guide was received and reviewed during inspection. Ms. Clark was reminded to keep anything that reads, “Keep Out of Reach of Children” to be inaccessible to children. Ms. Clark is reminded that any changes to the facility must be reported to and approved by Community Care Licensing. See 809-C for continuation...

SUPERVISORS NAME: Monica Cuddy
LICENSING EVALUATOR NAME: Samantha Clenista
LICENSING EVALUATOR SIGNATURE:	DATE:

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2021

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
CCLD Regional Office, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108

FACILITY NAME: KCE CHAMPIONS LLC AT ELEVATE MIDDLE	FACILITY NUMBER: 376105060
	VISIT DATE: 08/13/2021

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

This facility plans to provide Incidental Medical Services – IMS. For IMS information see Evaluator Manual – Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. 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)/ (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.

Ms. Clark states she understands that all staff must have a criminal record clearance and be associated to the facility prior to having a presence in the Center. Child Care Providers can now sign up for Quarterly Updates and PINS through the DSS website. Please go to www.ccld.ca.gov and click on “Receive Important Updates,” then enter your email address and choose which program you would like to subscribe to and click subscribe. LPA also shared and reviewed Playground Safety Handbook, Risk in Play article, YMCA Childcare Resource Service, Helping Young Children Cope with Disaster, Active Supervision Handout, and COVID-19 Early Care and Education handout.

No corrections are needed at the site. Ms. Clark was reminded that once the furniture that was purchased for Classroom 101 and 102 arrive, to provide pictures of it set up to LPA. A license for 50 school age children is granted and effective today's date, 08/13/2021.

SUPERVISORS NAME: Monica Cuddy
LICENSING EVALUATOR NAME: Samantha Clenista
LICENSING EVALUATOR SIGNATURE:	DATE: 08/13/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2021

LIC809 (FAS) - (06/04)

Page: 2 of 2