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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376701440
Report Date: 08/31/2021
Date Signed: 08/31/2021 02:07:14 PM

Document Has Been Signed on 08/31/2021 02:07 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 @ 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: 0CENSUS: 7DATE:
08/31/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Kendra HeathmanTIME COMPLETED:
02:15 PM
NARRATIVE
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On 8/31/21 @ 1:00PM, LPA Nancy Diaz conducted an unannounced inspection. LPA met and toured the facility with Kendra Heathman, Site Director. Observed present today were 7 school-age children. Staff Brandi Christman was also observed present today. Facility is currently utilizing Room 801 only. Hours of operation is in the afternoon only - Monday-Friday 2:10PM - 6:00PM; Thursday 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. At least one person is trained in CPR and Pediatric First aid was present today (Kendra Heathman - CPR/First Aid certificate is valid thru June 2023).

There were no bodies of water maintained within the premises. Disinfectants, cleaning solutions, poisons and other items that are dangerous to children are inaccessible. Facility is currently not maintaining medications. 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.

CONTINUED...
SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Nancy Diaz
LICENSING EVALUATOR SIGNATURE: DATE: 08/31/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/31/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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
CCLD Regional Office, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME: KCE CHAMPIONS LLC @ MASON
FACILITY NUMBER: 376701440
VISIT DATE: 08/31/2021
NARRATIVE
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The 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. Uncontaminated drinking water is readily available both indoors and out.

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, 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.

Incidental Medical Services (IMS) policy was discussed. 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

An exit interview was conducted with Ms. Heathman. A copy of this report and appeal rights were provided today. Notice of Site Visit was observed posted today. This notice shall remain posted for 30 days.

CONTINUED...
SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Nancy Diaz
LICENSING EVALUATOR SIGNATURE:

DATE: 08/31/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/31/2021
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Document Has Been Signed on 08/31/2021 02:07 PM - It Cannot Be Edited


Created By: Nancy Diaz On 08/31/2021 at 01:54 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 @ MASON
FACILITY NUMBER: 376701440

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/31/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/10/2021
Section Cited
HSC
1596.7995(a)(1)

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On or before March 30, 2018, a person who, on January 1, 2018 is a licensed daycare provider, administrator, or employee of a licensed day care facility shall complete the mandated reporter training...and shall complete renewal mandated reporter training every 2 years...
This requirement was not me as evidenced by:
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Ms. Heathman stated that she will renew her Mandated Reporter Training certificate no later than 9/10/2021. A copy of course certificate shall be submitted to the department no later than 9/10/21.
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Based on LPA's review of staff records, Kendra Heathman's Mandated Reporter Training course expired on 7/2021.
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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:Tashima Daniel
LICENSING EVALUATOR NAME:Nancy Diaz
LICENSING EVALUATOR SIGNATURE:
DATE: 08/31/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/31/2021


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