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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376105090
Report Date: 08/23/2022
Date Signed: 08/23/2022 01:53:35 PM

Document Has Been Signed on 08/23/2022 01:53 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:MADISON WALLERFACILITY TYPE:
840
ADDRESS:5454 RUFFIN ROADTELEPHONE:
(971) 378-2516
CITY:SAN DIEGOSTATE: CAZIP CODE:
92123
CAPACITY: 160TOTAL ENROLLED CHILDREN: 160CENSUS: 0DATE:
08/23/2022
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Madison WallerTIME COMPLETED:
02:15 PM
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On 8/23/22 at 1:30 PM, Licensing Program Analyst (LPA) Keturah Lane conducted an unannounced case management inspection at Licensee's request. The purpose of the visit is to approve the new playground for the facility. The facility serves children ages Kindergarten through 15 years old in rooms 106, Gymnasium and fitness lab. At the time of the inspection, the facility was closed, however staff members were on site preparing for the school to open on Thursday 8/25/22.
Upon arrival, LPA Lane met with Director Madison Waller and toured the facility and playground. Director stated there have been no changes to the size of the playground and the only change is the new structure installed. The new play structure was installed the end of May 2022. However, children did not play on the structure during the summer since the outside play area is large and has many grassy areas. There is a sticker attached to the structure that states it is designed for children ages 5 to 12 years. The structure is brand new and in good condition. There is appropriate wood chips installed it to provide sufficient cushioning. Playground is fully fenced.
LPA Lane advised Director to rake the wood chips often especially in places where children may land and that wood chips may need to be refilled as necessary for sufficient cushioning. LPA Lane also advised that if children in the program are not yet 5 years old, they should not play on the structure for liability reasons and another outdoor activity needs to be made available for them. LPA also advised that portions of the structure get very hot in the sun and to supervise children so they are not burned. There are shaded portions of the play area, but the structure itself is not shaded. LPA Lane advised to add shade (canopy or umbrella) for staff that are supervising near the structure.
LPA Lane has approved the structure for use effective today, 8/23/22. Exit interview conducted with facility representative, Director Madison Waller. Notice of Site visit was given and must remain posted for 30 days.
SUPERVISORS NAME: Monica Cuddy
LICENSING EVALUATOR NAME: Keturah Lane
LICENSING EVALUATOR SIGNATURE: DATE: 08/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/23/2022
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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