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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376701390
Report Date: 09/02/2021
Date Signed: 09/02/2021 03:01:44 PM

Document Has Been Signed on 09/02/2021 03:01 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 @ TIERRASANTAFACILITY NUMBER:
376701390
ADMINISTRATOR:ISAIAH BACONFACILITY TYPE:
840
ADDRESS:5606 ANTIGUA BOULEVARDTELEPHONE:
(858) 264-7759
CITY:SAN DIEGOSTATE: CAZIP CODE:
92124
CAPACITY: 70TOTAL ENROLLED CHILDREN: 0CENSUS: 9DATE:
09/02/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:Director Jennifer FlanniganTIME COMPLETED:
03:10 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 9/2/21 at 2:15 p.m., Licensing Program Analyst, Joelle Redding, met with Director for the purpose of an unannounced annual inspection. There were 9 children present with the Director and an Aide in Room B11. The other rooms are not operating at this time.Facility is within ratio and capacity. Program operates after school to 6 p.m. Thursdays are minimum days and school is out at 1:15 p.m.

LPA toured the facility. The furniture, books, games and toys are safe, age-appropriate and in good repair. Room was a comfortable temperature during this visit. No hazards were noted. All storage containers and trashes have tight fitting lids and are in good repair. Afternoon snack is provided. There is a refrigerator, storage cabinet and microwave in the room. Hand washing and toileting areas (elementary bathrooms - waiver in place) are in a safe, sanitary and operating condition. Staff checks them prior to use and supervises at the door. Medications are kept in a safe area, inaccessible to children. There are currently no medications in use. There is no evidence of rodent or insect activity. All children and staff were wearing masks and Covid-19 precautionary procedures were in place today.

Outdoor play area (field and blacktop) is fully fenced with sufficient cushioning and adequate shade, play structure and outdoor surfaces are in a safe condition. No hazards were noted. Portable water is used outdoors. There are no bodies of water, firearms or ammunition on the property. The carbon monoxide detector is operational, located a top the file cabinet near the door. LPA reviewed, sign in/out sheets, a sample of personnel records for a health screening and on-the-job training. A sample of children's records for emergency information and a medical assessment. Children are evaluated upon entry and monitored throughout the day for signs of illness. The isolation are for ill children awaiting pick up is a quiet area of the classroom. There is at least one staff present with current CPR and First Aid certification. SB 792 (staff immunizations) and AB 1207 (Mandated Reporter Training) requirements have been met. Facility is reminded the Mandated Reporter Training is to be retaken every two years and can be accessed at the following website: www.mandatedreporterca.com.
SUPERVISORS NAME: Renesha Pack
LICENSING EVALUATOR NAME: Joelle Redding
LICENSING EVALUATOR SIGNATURE: DATE: 09/02/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/02/2021
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
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 @ TIERRASANTA
FACILITY NUMBER: 376701390
VISIT DATE: 09/02/2021
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
26
27
28
29
30
31
32
This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual – Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. 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. Services are not in place

Licensee is signed up for Quarterly Updates and Provider Information Notices (PINs) for one or more programs on our website: www.ccld.ca.gov.

No deficiencies are cited.

NOTICE OF SITE VISIT WAS POSTED DURING THIS VISIT AND WILL REMAIN POSTED FOR 30 DAYS.
SUPERVISORS NAME: Renesha Pack
LICENSING EVALUATOR NAME: Joelle Redding
LICENSING EVALUATOR SIGNATURE:

DATE: 09/02/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/02/2021
LIC809 (FAS) - (06/04)
Page: 2 of 2