376105060-2-10-2023-51-CC-KLAE-CNX2ST-20230210163940

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 376105060
Report Date: 02/10/2023
Date Signed: 02/10/2023 04:39:51 PM

Document Has Been Signed on 02/10/2023 04:39 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:	JASMINE NELSON		FACILITY TYPE:	840
ADDRESS:	8404 PHYLLIS PLACE		TELEPHONE:	(619) 746-9178
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92123
CAPACITY: 50	TOTAL ENROLLED CHILDREN: 50	CENSUS: 3	DATE:	02/10/2023
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	03:50 PM
MET WITH:	Jasmine Nelson		TIME COMPLETED:	04:55 PM

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On 2/10/23 at 3:50 PM, Licensing Program Analysts (LPAs) Keturah Lane and Sherlynn Banas conducted a case management inspection at the facility at Licensee’s request. Licensee has requested to add a room to the operating space of the license. Facility is not requesting a capacity increase.

Upon arrival, LPAs met with facility representative Site Director Jasmine Nelson and toured the facility. This school-age program is located on a middle school site. LPAs observed 3 daycare children present with Site Director in classroom 102 at time of inspection.

During this visit, LPAs inspected the new classroom 205 on the second floor as well as the original classroom 102. Room 101 was unavailable to be inspected as it was locked. Site Director stated that they never use the classroom 101 because it is usually not available. Fire clearance was granted for all three classrooms on 2/6/23. First Aid Kit/Medication are located in labeled and locked cabinet in room 102. Both are kept inaccessible from children. Facility sign-in and outs are currently located in room 102. Once Room 205 is approved, Site Director stated they will be only using Room 205 and will no longer use Rooms 101 or 102. There are separate bathrooms available near room 205 approved for use. Medication & First aid kits will be in a labeled, locked cabinet in room 205 along with sign-in and out sheets. (continued on LIC-809C...)

SUPERVISORS NAME: Monica Cuddy
LICENSING EVALUATOR NAME: Keturah Lane
LICENSING EVALUATOR SIGNATURE:	DATE: 02/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/10/2023

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
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: 02/10/2023

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Per H&S Code 1596.806, facility is exempt from square footage, toilet, isolation space, outdoor activity space and fencing requirements. All indoor and outdoor activity spaces utilized for the school age children were inspected. Rooms 102 & 205 were observed to have age-appropriate furniture and equipment, including tables, chairs, bookshelves and other activity supplies for the children. Rooms have white laundry baskets for children’s belongings. LPA observed separate bathrooms with privacy.

There is an operational carbon monoxide detector located in classroom 102. Snack menu is posted, as well as all other required documents. LPAs observed snacks/food preparation area and observed to be free of rodents and/or vermin. Snacks are located in locked cabinet in room 102. All foods/beverages capable of rapid spoiling are stored in covered containers at 45 F or less.

The outdoor playground area was inspected. Area has trees for shade. Drinking water is readily accessible inside and outside the classroom. Children bring water bottles and if they do not have one, the facility will provide a water bottle for the child. Facility representative is reminded that any changes to the facility must be reported to and approved by Community Care Licensing.

No deficiencies were cited at this inspection.

Upon final file review, Room 205 may be approved for use by the facility and added to the license. Exit interview conducted and report was reviewed with facility representative Site Director Jasmine Nelson. A notice of site visit was provided and must remain posted for 30 days.

SUPERVISORS NAME: Monica Cuddy
LICENSING EVALUATOR NAME: Keturah Lane
LICENSING EVALUATOR SIGNATURE:	DATE: 02/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/10/2023

LIC809 (FAS) - (06/04)

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