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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376701464
Report Date: 10/20/2023
Date Signed: 10/20/2023 09:15:37 AM

Document Has Been Signed on 10/20/2023 09:15 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MISSION VALLEY, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME:KCE CHAMPIONS LLC AT VILLAGE ELEMENTARYFACILITY NUMBER:
376701464
ADMINISTRATOR:ALEXIE GATESFACILITY TYPE:
840
ADDRESS:600 SIXTH STREETTELEPHONE:
(619) 865-1577
CITY:CORONADOSTATE: CAZIP CODE:
92118
CAPACITY: 196TOTAL ENROLLED CHILDREN: 196CENSUS: 10DATE:
10/20/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
07:45 AM
MET WITH:Ruby Carrasco, Facility Representative TIME COMPLETED:
09:35 AM
NARRATIVE
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On 10/20/2023 at 7:45 am, Licensing Program Analyst (LPA), Michelle Hood, made an unannounced inspection to follow up on a self reported incident wherein a 5 year old child was missing for appropriately 10 mins. after signing in at the facility. The director joined the inspection at 9:00 am

LPA reviewed the sign-in sheet for 09/14/2023 and obtained a copy. The sign-in sheet reviewed shows the was signed in at 2:45 pm, along with 24 other children. During a second headcount at 3:05 pm, the child was not accounted for. It was reported the child left the facility, and took a school bus with a friend. The child was missing for appropriately 15-20 minutes.

LPA Michelle Hood informed facility representative Ruby Carrasco that this report dated 10/20/2023 with one Type A citation which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care.

Also, LPA Michelle Hood informed the facility representative to provide a copy of this licensing report dated 10/20/2023 that documents any Type A citation(s) 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.

An exit interview was conducted and the report was reviewed with the facility representative Ruby Carrasco. Carrasco was provided a copy of their appeal rights (LIC 9058 12/15) and their signature on this form acknowledges receipt of these rights. Notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100. See the 809D page for the deficiency cited under regulation 101229 (a)(1) - Responsibility for Providing Care and Supervision
SUPERVISORS NAME: Cynthia Gray
LICENSING EVALUATOR NAME: Michelle Hood
LICENSING EVALUATOR SIGNATURE: DATE: 10/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/20/2023
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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Document Has Been Signed on 10/20/2023 09:15 AM - It Cannot Be Edited


Created By: Michelle Hood On 10/13/2023 at 02:10 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 VILLAGE ELEMENTARY
FACILITY NUMBER: 376701464

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/20/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/23/2023
Section Cited
CCR
101229(a)(1)

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101229(a)(1) - Responsibility for Providing Care and Supervision- The licensee shall provide care and supervision as necessary to meet the children's needs. No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation. This requirement was not met by:
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The facility representaive stated the facility purchased a Ring doorbell, so the staff can kept the front door closed. The director and staff will watch the following training videos. Active Supervision and Outside play, and Active Supervision Keeps Kids Safe.
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On 09/14/2023, after a head count a child left the facility, proceeded on a school bus with a friend. The child was mising from the facility for 15 to 20 minutes. This is a risk to children in care.
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The Director is going to conduct a zoning and supervision training, staff will watch the Supervising Children in Child Care Centers on CCLD website and submit the staff summary of the videos, and what they staff feel they can do to ensure the children are supervised at all times.

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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:Cynthia Gray
LICENSING EVALUATOR NAME:Michelle Hood
LICENSING EVALUATOR SIGNATURE:
DATE: 10/20/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/20/2023


LIC809 (FAS) - (06/04)
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