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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376105090
Report Date: 12/23/2021
Date Signed: 12/23/2021 03:21:14 PM

Document Has Been Signed on 12/23/2021 03:21 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 INNOVATIONS ACADEMYFACILITY NUMBER:
376105090
ADMINISTRATOR:ROBYN CLARKFACILITY TYPE:
840
ADDRESS:5454 RUFFIN ROADTELEPHONE:
(619) 746-9178
CITY:SAN DIEGOSTATE: CAZIP CODE:
92123
CAPACITY: 160TOTAL ENROLLED CHILDREN: 160CENSUS: 0DATE:
12/23/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
02:10 PM
MET WITH:Robyn ClarkTIME COMPLETED:
03:35 PM
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On 12/23/2021 at 2:10pm, Licensing Program Analyst (LPA), Samantha Clenista conducted an announced Pre-Licensing inspection. LPA met with Facility Representative, Robyn Clark (Area Manager) and Madison Waller (Site Director) and other KCE Site Director's who were shadowing; Danielle Cabanaugh and Marissa Lujan. A tour of the facility was conducted. This program will be using room 106, gymnasium and fitness lab located at Innovations Academy (public charter school). A fire clearance was granted on 12/16/2021. The program will use the bathrooms (girls and boys) located in the hallway that afford privacy. There is also a restroom located in Room 106 that afford privacy. 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 the building. Outdoor play space include tables, age appropriate play equipment and canopies/trees used for shade. Room 106 is equipped with tables and chairs and age appropriate equipment and activities. Facility submitted a plan of operation to ensure supervision is in place and exclusive use of the classrooms and activity space during indoor and outdoor activities. Drinking water is readily accessible via water bottles and refillable water jugs/stations. Snacks will be provided and prepared in Room 106. There is a refrigerator on site in the kitchen. Bathrooms and classroom sinks have hot and cold running water. Room 106 has storage space for food. There is an operational carbon monoxide detector in Room 106. Sign-in area is located inside Room 106. All COVID-19 posters are posted. Ms. Clark and Site Director 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. There is no bodies of water on the premises. There are no firearms or ammunition on the premises. Disinfectants, cleaning solutions, medication and other hazardous items are made inaccessible. No poisons were observed during the inspection.

See 809-C for continuation...
SUPERVISORS NAME: Monica Cuddy
LICENSING EVALUATOR NAME: Samantha Clenista
LICENSING EVALUATOR SIGNATURE: DATE: 12/23/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/23/2021
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 INNOVATIONS ACADEMY
FACILITY NUMBER: 376105090
VISIT DATE: 12/23/2021
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This facility plans to provide Incidental Medical Services – IMS. However, no medications were on site for LPA to review. 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 and Site Director stated they 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.

A license for 160 school-aged children (K-15 years old) may be granted upon final file review. An exit interview was conducted with Ms. Clark and Site Director.
SUPERVISORS NAME: Monica Cuddy
LICENSING EVALUATOR NAME: Samantha Clenista
LICENSING EVALUATOR SIGNATURE:

DATE: 12/23/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/23/2021
LIC809 (FAS) - (06/04)
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