<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376701350
Report Date: 11/30/2023
Date Signed: 11/30/2023 03:06:57 PM

Document Has Been Signed on 11/30/2023 03:06 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 - DeficienciesUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Victoria AlbertsonTIME COMPLETED:
03:15 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 11/30/2023 @ 2:30PM, Licensing Program Analyst (LPA) Nancy Diaz conducted an unannounced case management inspection. Observed present today were 17 school-age children with staff Megan Waples and Samantha Seabrooks in Room B13.

Type B deficiency was cited today. Civil penalty was assessed.

Please be advised that FAILURE TO PAY the required civil penalty payment may result in in the REVOCATION OF YOUR LICENSE. You must respond within 30 days with the payment of or a proposed payment plan that includes the first payment. Further, the Department will not approve any requests for increase in capacity or for additional capacity of additional licenses while civil penalties remain unpaid.

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
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
Document Has Been Signed on 11/30/2023 03:06 PM - It Cannot Be Edited


Created By: Nancy Diaz On 11/30/2023 at 02:28 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
101170(e)(2)

1
2
3
4
5
6
7
CRIMINAL RECORD CLEARANCE.
(2) Request a transfer of a criminal record clearance as specified in Section 101170(f) ...

This requirement was not met as evidenced by:
1
2
3
4
5
6
7
CORRECTED ON THE SPOT.
Ms. Albertson associated staff on the Guardian database during this inspection.
8
9
10
11
12
13
14
Based on record review, staff Samantha Seabrooks' fingerprint clearance is not associated to the facility. Failure to associate staff poses a potential risk to the health, safety or personal rights of children in care.
8
9
10
11
12
13
14

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
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)
Page: 2 of 2