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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 406215258
Report Date: 06/04/2024
Date Signed: 06/04/2024 04:26:34 PM

Document Has Been Signed on 06/04/2024 04:26 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, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME:KCE CHAMPIONS LLC @ SANTA ROSA PSFACILITY NUMBER:
406215258
ADMINISTRATOR/
DIRECTOR:		TAMARA PAYNE-ALEXFACILITY TYPE:
850
ADDRESS:8655 SANTA ROSA ROADTELEPHONE:
(805) 712-9485
CITY:ATASCADEROSTATE: CAZIP CODE:
93423
CAPACITY: 23TOTAL ENROLLED CHILDREN: 23CENSUS: DATE:
06/04/2024
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:45 PM
MET WITH:Rhianna MerigoldTIME VISIT/
INSPECTION COMPLETED:
04:30 PM
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On 6/4/24, at 2:45 PM, Licensing Program Analyst (LPA) Elvin Baddley conducted an unannounced Case Management inspection of the abovementioned Child Care Center (CCC) as the CCC is requesting permission to relocate to another classroom within the elementary school. LPA note the CCC operates out of a classroom on the grounds of the Santa Rosa Academic Academy. LPA met with Rhianna Merigold, Site Supervisor of the CCC, and explained the purpose of the inspection. LPA notes 8 children are present along with one teacher providing care and supervision at the time of the inspection.

LPA, in the company of Site Supervisor, toured the interior and exterior of the CCC (Room 204), as well as the proposed relocation classroom (Room 701). The proposed relocation classroom is also on the grounds of Santa Rosa Elementary School. The CCC planned to relocate to Room 701 in the Fall of 2024 School Year.

LPA observed Room 701 to have two exits and accommodations to support child care services. Room 701 has running water, a carbon monoxide detector and centralized air conditioning. Age appropriate furnishing and equipment will be moved into the classroom from the primarily CCC. Room 701 is in proximity to restrooms for children in care are well as an outdoor play area. CCC is planning to use existing outdoor play area. Site Supervisor is reminded to ensure child in care are not accessing play structure which are not age appropriate. The square footage of the classroom, as well as available toilets and sinks, are comparable to the classroom the existing CCC is in. The capacity of the CCC will be unchanged by the relocation form Room 204 to Room 701.

It is been determined Room 701 is feasible to support child care services. As such, the CCC is granted permission to relocation to Room 701 from Room 204, pending a fire clearance from the local Fire Department Inspector. LPA notes CCLD requested a Fire Clearance inspection on 8/14/23.

No deficiencies have been cited during todays visit.
(CONT. 809-C, Page 2)
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Elvin Baddley
LICENSING EVALUATOR SIGNATURE: DATE: 06/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/04/2024
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
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: KCE CHAMPIONS LLC @ SANTA ROSA PS
FACILITY NUMBER: 406215258
VISIT DATE: 06/04/2024
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A Notice of Site Visit (LIC 9213) and Appeal Rights (LIC 9058) were given to Site Supervisor and Notice of Site Visit must remain posted for 30 days or a civil penalty of $100 may apply.

Exit interview conducted and report was reviewed with the Facility representative Rhianna Merigold.

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Elvin Baddley
LICENSING EVALUATOR SIGNATURE:

DATE: 06/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/04/2024
LIC809 (FAS) - (06/04)
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