376701440-9-10-2024-51-CC-NDIZ-D8YT97-20240910143127

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 376701440
Report Date: 09/10/2024
Date Signed: 09/10/2024 02:31:38 PM

Document Has Been Signed on 09/10/2024 02:31 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 MASON		FACILITY NUMBER:	376701440
ADMINISTRATOR/ DIRECTOR:	KENDRA HEATHMAN		FACILITY TYPE:	840
ADDRESS:	10340 SAN RAMON DRIVE		TELEPHONE:	(619) 746-9178
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92126
CAPACITY: 60	TOTAL ENROLLED CHILDREN: 60	CENSUS: 0	DATE:	09/10/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	01:31 PM
MET WITH:	Veronica Rivera		TIME VISIT/ INSPECTION COMPLETED:	02:45 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 9/10/24 @ 1:31PM, LPA Nancy Diaz conducted an unannounced inspection. LPA disclosed the purpose of the inspection and was granted facility entry by Veronica Rivera, Site Supervisor. LPA toured the facility, indoors and outdoor. There were no school-age children observed present today. Staff Marlynn Bryson was also present today. Bungalow #801 has been designated for school-age use. Program operates Monday, Tuesday, Wednesday & Friday - 2:15pm-6:00pm and Thursday at 12:15pm - 6:00pm. 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. Ms. Rivera is trained in CPR and Pediatric First aid, certificate is valid thru 8/2025. 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 did not maintain a carbon monoxide detector. The kitchen, 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. 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.

SUPERVISORS NAME: Joelle Redding
LICENSING EVALUATOR NAME: Nancy Diaz
LICENSING EVALUATOR SIGNATURE:	DATE: 09/10/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2024

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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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 MASON	FACILITY NUMBER: 376701440
	VISIT DATE: 09/10/2024

NARRATIVE

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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. 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. For IMS information see PIN 22-02- CCP. 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) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/.

Facility representative was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

SUPERVISORS NAME: Joelle Redding
LICENSING EVALUATOR NAME: Nancy Diaz
LICENSING EVALUATOR SIGNATURE:	DATE: 09/10/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2024

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 MASON	FACILITY NUMBER: 376701440
	VISIT DATE: 09/10/2024

NARRATIVE

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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.

Facility representative was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

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

LPA Nancy Diaz informed Veronica Rivera, Site Supervisor that this report dated September 10, 2024 documents one Type A citation which shall be posted for 30 consecutive days as there are immediate risks to the health, safety, or personal rights of children in care.
Also, LPA Nancy Diaz informed the Site Supervisor to provide a copy of this licensing report dated September 10, 2024 that documents any Type A citations 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.
Exit interview conducted and report was reviewed with facility representative, Veronica Rivera. 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: Joelle Redding
LICENSING EVALUATOR NAME: Nancy Diaz
LICENSING EVALUATOR SIGNATURE:	DATE: 09/10/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2024

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 09/10/2024 02:31 PM - It Cannot Be Edited

Created By: Nancy Diaz On 09/10/2024 at 01:46 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 MASON	FACILITY NUMBER: 376701440
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/10/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

HSC

1596.954

Licensure Requirements

Every licensed child day care center shall have one or more carbon monoxide detectors in the facility that meet the standards established in Chapter 8 (commencing with Section 13260) of Part 2 of Division 12. The department shall account for the presence of these detectors during inspections. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation and interview, the licensee did not comply with the section cited above. Facility did not have a carbon monoxide detector in the school-age classroom. This poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 09/11/2024
	Plan of Correction
1 2 3 4	Ms. Rivera stated that she will obtain and install a carbon monoxide detector no later than 9/11/2024. She will submit a photo of an installed carbon monoxide detector and a video to show the device being tested no later than 9/11/2024.

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:

Joelle Redding

LICENSING EVALUATOR NAME:

Nancy Diaz

LICENSING EVALUATOR SIGNATURE:

DATE: 09/10/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2024

LIC809 (FAS) - (06/04)

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