376105060-9-27-2023-51-CC-KLAE-CW3VJU-20230927162919

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 376105060
Report Date: 09/27/2023
Date Signed: 09/27/2023 04:29:28 PM

Document Has Been Signed on 09/27/2023 04:29 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
SAN DIEGO N. CC RO, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108

FACILITY NAME:	KCE CHAMPIONS LLC AT ELEVATE MIDDLE		FACILITY NUMBER:	376105060
ADMINISTRATOR:	JOCELYN DE LA RIVA		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: 6	DATE:	09/27/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	02:35 PM
MET WITH:	Jocelyn De La Riva		TIME COMPLETED:	04:40 PM

NARRATIVE

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On 9/27/23 at 2:35 PM, Licensing Program Analyst (LPA) Keturah Lane conducted an unannounced annual inspection at the facility. Upon arrival, LPA met with facility representative Site Director Jocelyn De La Riva. This school-age program is located on a private middle school site. LPA observed 6 school-age daycare children present with staff member Site Director Jocelyn De La Riva.

During this visit, LPA inspected classroom #205. This is the only classroom in use at the facility. Rooms #101 and #102 are licensed, but currently not in use. First Aid Kit/Medication are located in locked cabinets in back of the room. Both are kept inaccessible from children. Facility sign-in and outs are located outside of classroom.

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. Classroom #205 was observed to have age-appropriate furniture and equipment, including tables, chairs, bookshelves and other activity supplies for the children. Room has baskets for children’s belongings. LPA observed separate bathrooms with privacy. (continued on LIC809-C...)

There is a separate bathroom utilized for ill children downstairs by front office. The carbon monoxide detector was not functioning. Site Director stated she would get it replaced and send proof to LPA via video through e-mail. Snack menu is posted, as well as all other required documents. LPA observed snacks/food preparation area and observed to be free of rodents and/or vermin. Snacks are located in locked storage cabinet at back of room. The refrigerator location is also at the back of the room and has a latch. All foods/beverages capable of rapid spoiling are stored in covered containers at 45 F or less. (continued on LIC809-C...)

SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Keturah Lane
LICENSING EVALUATOR SIGNATURE:	DATE: 09/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2023

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
SAN DIEGO N. CC RO, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108

FACILITY NAME: KCE CHAMPIONS LLC AT ELEVATE MIDDLE	FACILITY NUMBER: 376105060
	VISIT DATE: 09/27/2023

NARRATIVE

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The outdoor playground area was inspected. Area has trees for shade. LPA observed grassy area that children use for the outside play area on one side of the school building. Drinking water is readily accessible inside and outside the classroom via water bottles. Extra water bottles are available if needed. Facility representative is reminded that any changes to the facility must be reported to and approved by Community Care Licensing.

Children’s records were reviewed and LPA observed admission and emergency contact information completed. LPA reviewed staff records for Site Director Jocelyn De La Riva and observed mandated reporter training expiring 4/21/25 and CPR/First Aid expiring 4/2025. Site Director is fully qualified and has all other required documents in the facility file.

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 childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.

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). LPA verified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP.

(continued on LIC809-C)...

SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Keturah Lane
LICENSING EVALUATOR SIGNATURE:	DATE: 09/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2023

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
SAN DIEGO N. CC RO, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108

FACILITY NAME: KCE CHAMPIONS LLC AT ELEVATE MIDDLE	FACILITY NUMBER: 376105060
	VISIT DATE: 09/27/2023

NARRATIVE

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This facility provides Incidental Medical Services – IMS. LPA reviewed storage of “medication and equipment/supplies, and reviewed children’s, personnel, and administrative records.

For IMS information see PIN 22-02-CCP. 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-carecenters/.

See LIC809-D for Type B deficiency cited.

To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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/process.

Exit interview conducted and report was reviewed with facility representative Site Director Joceyln De La Riva.

A notice of site visit was provided and must remain posted for 30 days.

SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Keturah Lane
LICENSING EVALUATOR SIGNATURE:	DATE: 09/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 09/27/2023 04:29 PM - It Cannot Be Edited

Created By: Keturah Lane On 09/27/2023 at 04:04 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
, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108

FACILITY NAME: KCE CHAMPIONS LLC AT ELEVATE MIDDLE	FACILITY NUMBER: 376105060
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/27/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1596.954

Licensure Requirements

Every licensed child day care center shall have one or more carbon monoxide detectors in the facility that meet the standards established in Chapter 8 (commencing with Section 13260) of Part 2 of Division 12. The department shall account for the presence of these detectors during inspections. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on LPA observation and interview with Site Director, the licensee did not comply with the section cited above which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 10/04/2023
	Plan of Correction
1 2 3 4	Site Director stated she would obtain a functioning carbon monoxide detector and send video of testing to LPA Lane via e-mail: Keturah.Lane@dss.ca.gov by 10/4/23.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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:

Tashima Daniel

LICENSING EVALUATOR NAME:

Keturah Lane

LICENSING EVALUATOR SIGNATURE:

DATE: 09/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2023

LIC809 (FAS) - (06/04)

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