376701350-1-9-2023-51-CC-NDIZ-CMX2S9-20230109163845

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 376701350
Report Date: 01/09/2023
Date Signed: 01/09/2023 04:39:01 PM

Document Has Been Signed on 01/09/2023 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 WALKER ELEMENTARY		FACILITY NUMBER:	376701350
ADMINISTRATOR:	VICTORIA ALBERTSON		FACILITY TYPE:	840
ADDRESS:	9225 HILLERY DRIVE		TELEPHONE:	(619) 746-9178
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92126
CAPACITY: 100	TOTAL ENROLLED CHILDREN: 100	CENSUS: 25	DATE:	01/09/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	02:25 PM
MET WITH:	Kendra Heathman		TIME COMPLETED:	05:00 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 1/09/2023 @ 2:25PM, LPA Nancy Diaz conducted an unannounced inspection. LPA disclosed the purpose of the inspection and was granted facility entry by Destiny Dickerson, lead staff. KCE Champions director (from Mason Elementary) assisted LPA with providing children and staff files. Observed present today were 25 children with staff Destiny Dickerson & Nick Amaro. Children were observed engaged in various indoor and outdoor activities. Classroom B13 is designated for children's use. A review of staff records on this date indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse clearances or exemptions. The licensee has not exceeded the conditions, limitations and capacity specified on the license. At least one person is trained in CPR and Pediatric First aid was present today (staff). Disinfectants, cleaning solutions, poisons and other items that are dangerous to children are inaccessible. Medications are kept in a safe place, inaccessible to children. Furniture and equipment are in good condition, free of sharp, loose or pointed parts. All toilets, handwashing facilities are in safe and sanitary operating condition. All floors are clean and safe. The child care center was observed to be clean, safe, sanitary and in good repair to ensure the safety and well-being of children, employees and visitors. Facility maintains a carbon monoxide detector that meet the standards established in Chapter 8 of Part 2 of Division 12. The food-preparation and storage areas are kept clean, free of litter. Food are protected against contamination. All storage containers for solid waste have a tight-fitting covers that are kept on and in good repair.

SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Nancy Diaz
LICENSING EVALUATOR SIGNATURE:	DATE: 01/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2023

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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Document Has Been Signed on 01/09/2023 04:39 PM - It Cannot Be Edited

Created By: Nancy Diaz On 01/09/2023 at 04:14 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 WALKER ELEMENTARY	FACILITY NUMBER: 376701350
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/09/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101217(a)(6)

Personnel Records

(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information: (6) Documentation of the educational background, training and/or experience specified in this chapter. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above. LPA was unable to verify site director's completion of Administration class. Facility's failure to maintain director's proof of Administration course completion poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 01/16/2023
	Plan of Correction
1 2 3 4	Site Director shall submit proof of Administration course completion to the department no later than 1/16/2023.

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:

Nancy Diaz

LICENSING EVALUATOR SIGNATURE:

DATE: 01/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2023

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

FACILITY NAME: KCE CHAMPIONS LLC AT WALKER ELEMENTARY	FACILITY NUMBER: 376701350
	VISIT DATE: 01/09/2023

NARRATIVE

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Playground equipment was observed to be in safe condition, free of sharp, loose or pointed parts. The surface of the outdoor activity space are maintained in safe condition and free of hazards.

Children were observed to be under the supervision of qualified staff. Facility was observed to be within ratio. An isolation area has been designated for children who becomes ill during the day.

Children’s records were reviewed today. All required forms were on file. Menus are posted in a place visible by the child’s authorized representative. All children are signed in/out by a representative who uses a full legal signature and has recorded the time of day. Child’s record also contain a medical assessment.

Staff records reviewed today contain a health screening as required by the regulation.
Staff have completed the mandated reporter training (effective 3/2018). This training shall be renewed every two years. All staff have immunization record indicating that they have been immunized against influenza, pertussis and measles.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated 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

SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Nancy Diaz
LICENSING EVALUATOR SIGNATURE:	DATE: 01/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2023

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

FACILITY NAME: KCE CHAMPIONS LLC AT WALKER ELEMENTARY	FACILITY NUMBER: 376701350
	VISIT DATE: 01/09/2023

NARRATIVE

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Facility representative was reminded that all adults 18 and over, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPA received updated forms: LIC 610, LIC 500 and Children's Roster.

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.

TYPE B DEFICIENCY WAS CITED TODAY. TYPE B DEFICIENCY IF NOT CORRECTED POSES A POTENTIAL RISK TO THE HEALTH, SAFETY OR PERSONAL RIGHTS OF CHILDREN IN CARE.

SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Nancy Diaz
LICENSING EVALUATOR SIGNATURE:	DATE: 01/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2023

LIC809 (FAS) - (06/04)

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