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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376701440
Report Date: 05/16/2023
Date Signed: 05/16/2023 03:12:43 PM

Document Has Been Signed on 05/16/2023 03:12 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 MASONFACILITY NUMBER:
376701440
ADMINISTRATOR:KENDRA HEATHMANFACILITY TYPE:
840
ADDRESS:10340 SAN RAMON DRIVETELEPHONE:
(619) 746-9178
CITY:SAN DIEGOSTATE: CAZIP CODE:
92126
CAPACITY: 60TOTAL ENROLLED CHILDREN: 60CENSUS: DATE:
05/16/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:TIME COMPLETED:
03:30 PM
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On 5/16/23 @ 2:15PM, LPA Nancy Diaz conducted an unannounced inspection. LPA disclosed the purpose of the inspection and was granted facility entry by Kendra Heathman, Site Director. LPA toured the facility with Ms. Heathman. Observed present today were 7 school-age children. Staff Ayla Wood was observed supervising the 7 children present today. Room #801 is designated specific to the school-age children. Program operates 2:10PM-6PM on Mondays, Tuesdays, Wednesday and Fridays and from 12:15pm-6pm on Thursdays.

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. Both staff present today are trained in CPR and Pediatric First aid.

Disinfectants, cleaning solutions, poisons and other items that are dangerous to children are inaccessible. 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.

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. The areas around or under high climbing equipment, swings, slides, and similar equipment was cushioned with material that absorbs a fall.

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.
SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Nancy Diaz
LICENSING EVALUATOR SIGNATURE: DATE: 05/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/16/2023
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
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 MASON
FACILITY NUMBER: 376701440
VISIT DATE: 05/16/2023
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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.

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. Facility currently do not maintain medications for children. 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

Site director 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.

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.

NO DEFICIENCY CITED TODAY.
Exit interview conducted and report was reviewed with facility representative, Kendra Heathman. A copy of this report, along with Appeal Rights (LIC9058), were provided. A notice of site visit was given and must remain posted for 30 days. LPA observed that the notice of site visit was posted during the inspection. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Nancy Diaz
LICENSING EVALUATOR SIGNATURE:

DATE: 05/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2023
LIC809 (FAS) - (06/04)
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