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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376701350
Report Date: 11/30/2023
Date Signed: 11/30/2023 03:02:39 PM

Document Has Been Signed on 11/30/2023 03:02 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 WALKER ELEMENTARYFACILITY NUMBER:
376701350
ADMINISTRATOR:VICTORIA ALBERTSONFACILITY TYPE:
840
ADDRESS:9225 HILLERY DRIVETELEPHONE:
(619) 746-9178
CITY:SAN DIEGOSTATE: CAZIP CODE:
92126
CAPACITY: 100TOTAL ENROLLED CHILDREN: 100CENSUS: 17DATE:
11/30/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:50 PM
MET WITH:Victoria AlbertsonTIME COMPLETED:
02:30 PM
NARRATIVE
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On 11/30/2023 @ 1:50PM, Licensing Program Analyst (LPA) Nancy Diaz conducted an unannounced case management in reference to a self-reported unusual incident that occurred on 10/09/2023, 10/10/2023 & 10/11/2023. The unusual incident report indicated that there were 4 children (ages 8 years old) were involved in inappropriate activities under a blanket. One of the children reported this incident to the director on 11/8/2023.

Observed present today were 17 school-age children and staff Megan Waples & Samantha Seabrooks in Room B13.

Ms. Albertson stated that there were 8 children on 10/09/2023; 9 children on 10/10/2023 and 11 children on 10/11/2023 with one teacher. Staff who was in charge of supervising these children did not observed the inappropriate activities that happened on 10/09/2023, 10/10/2023 & 10/11/2023. Ms. Albertson stated that the staff is no longer employed at KCE. Ms. Albertson stated that on November 11, 2023 during a professional development day, staff were trained on active supervision.

Type A deficiency was cited today.
LPA Nancy Diaz informed site director, Victoria Albertson that this report dated November 30, 2023 documents a Type A citation which shall be posted for 30 consecutive days as there is immediate risk to the health, safety, or personal rights of children in care.
Also, LPA Nancy Diaz informed the director, Victoria Albertson to provide a copy of this licensing report dated 11/30/2023 that documents any Type A citation to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.
SUPERVISORS NAME: Joelle Redding
LICENSING EVALUATOR NAME: Nancy Diaz
LICENSING EVALUATOR SIGNATURE: DATE: 11/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/30/2023
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 11/30/2023 03:02 PM - It Cannot Be Edited


Created By: Nancy Diaz On 11/30/2023 at 02:17 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: 11/30/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/30/2023
Section Cited
CCR
101229(a)(1)

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RESPONSIBILITY FOR PROVIDING CARE AND SUPERVISION.
No child(ren) shall be left without the supervision of a teacher at any time...

This requirement was not met as evidenced by:
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CORRECTED.
Ms. Albertson stated that the agency conducted a training on active supervision on November 11, 2023. Ms. Albertson provided a copy of the agenda and a list of attendees.
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Based on the self-reported incident, staff in charge of the group failed to provide appropriate supervision wherein 4 children were engaged in inappropriate activities for 3 days. Children went under a blanket and looked at each other's genitals. Staff's failure to provide appropriate supervision poses an immediate risk to the health, safety or personal rights of children in care.
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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:Joelle Redding
LICENSING EVALUATOR NAME:Nancy Diaz
LICENSING EVALUATOR SIGNATURE:
DATE: 11/30/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/30/2023


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 WALKER ELEMENTARY
FACILITY NUMBER: 376701350
VISIT DATE: 11/30/2023
NARRATIVE
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Exit interview was conducted with Ms. Albertson. A copy of this report, appeal rights and notice of site visit were provided today. Notice of site visit was observed posted and must remain posted for 30 days.
SUPERVISORS NAME: Joelle Redding
LICENSING EVALUATOR NAME: Nancy Diaz
LICENSING EVALUATOR SIGNATURE:

DATE: 11/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/30/2023
LIC809 (FAS) - (06/04)
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