406215807-10-1-2024-17-CC-EBAY-D9M2K5-20240930172721

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 406215807
Report Date: 09/30/2024
Date Signed: 10/01/2024 05:56:37 PM

Document Has Been Signed on 10/01/2024 05:56 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 @ VINEYARD ELEMENTARY		FACILITY NUMBER:	406215807
ADMINISTRATOR/ DIRECTOR:	DAWN MARTIN		FACILITY TYPE:	840
ADDRESS:	2121 VINEYARD DRIVE		TELEPHONE:	(408) 348-1610
CITY:	TEMPLETON	STATE: CA	ZIP CODE:	93465
CAPACITY: 75	TOTAL ENROLLED CHILDREN: 75	CENSUS: 33	DATE:	09/30/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	03:10 PM
MET WITH:	Kayleen Barger		TIME VISIT/ INSPECTION COMPLETED:	05:30 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 9/30/24, at 3:10 PM, Licensing Program Analysts (LPAs) Elvin Baddley and Matthew Sapien conducted an unannounced Annual/Random inspection of the abovementioned Child Care Center (CCC). LPAs met with Kayleen Barger, Site Supervisor of the CCC. LPAs explained the purpose and nature of the inspection. The facility is located on the grounds of Vineyard Elementary School. The school-age program operates Monday – Friday 7:00 AM – 8:15 AM and Monday, Tuesday, Thursday, Friday from 2:30 PM - 6:00 PM and Wednesday from 1:30 PM - 6:00 PM. Currently the facility uses two classroom (D-1 and D-2) for child care services. The CCC also operates out of the school's Multipurpose Room. At the time of inspection, LPAs observed 33 children on site, along with three teachers. The CCC's Site Supervisor is assisting with the care and supervision of children on site. LPAs observed required licensing forms and documents posted near the main door entry of D-1. A menu is also posted in a visible location. The CCC's Sign In/Out forms were reviewed by LPAs. The forms contained the arrival and departure times of children in care and well as the signatures of the children's authorized representatives. The classrooms of the CCC are clean and orderly. The classrooms have age appropriate equipment and furnishings available to children in care. The CCC's carbon monoxide detector is integrated in the classroom's fire detection's system. The detector was not tested by LPAs. Site Supervisor informed LPAs the fire detection system is regularly tested and monitored by school services The CCC uses two restrooms. All restrooms are in sanitary operating condition. The CCC shares the restrooms with other children in school, however CCC children are monitored by CCC staff when using the restrooms. LPAs observed an mini operable refrigerator in the classroom (D-1) which contained food for the children. The CCC provides an afternoon snacks to children in care. Lunch is not provided to children in care at the CCC. The CCC also has available filtered drinking water for children inside and outside of the facility. CCCs constructed before 1/1/20, to test their water (used for drinking and food preparation) for lead contamination before 1/1/23, and then every 5-years except after the date of the first test. For child care center licenses issued after 7/1/22, the licensee shall test their water for (CONT. LIC 809-C, Page 2)

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Elvin Baddley
LICENSING EVALUATOR SIGNATURE:	DATE: 09/30/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2024

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 @ VINEYARD ELEMENTARY	FACILITY NUMBER: 406215807
	VISIT DATE: 09/30/2024

NARRATIVE

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lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1-CCP). LPAs verified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP.

Disinfectants, cleaning solutions and sharps are observed in locations accessible to staff members but inaccessible to children in care.

The CCC outdoor playground areas are enclosed by chain linked fencing. The fence’s entry/exit gates are secured. The surfaces of the outdoor playground areas are varied. LPAs observed age appropriate play equipment in the play areas. The play equipment is free of sharp, loose or pointed objects. The play structures in the outdoor playground areas have adequate cushioning materials to absorb falls. No bodies of water are observed on site.

A sampling of staff and children records were reviewed. The children’s records were complete and found to contain emergency contact information, among other required licensing documentation and forms. Staff records were reviewed. At 4:20 PM, LPAs reviewed Mandated Reporter training certifications for staff and found S1's Mandated Reporter Training certification expired 7/20/23. Site Supervisor was remained to ensure training certification are kept current. Site Supervisor notes no firearms or ammunition are stored on site.

This facility provides Incidental Medical Services – IMS. LPAs reviewed storage of “medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see PIN 22-02-CCP. 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,
as specified in HSC 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. (CONT. 809-C, Page 3)

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Elvin Baddley
LICENSING EVALUATOR SIGNATURE:	DATE: 09/30/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2024

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
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: KCE CHAMPIONS LLC @ VINEYARD ELEMENTARY	FACILITY NUMBER: 406215807
	VISIT DATE: 09/30/2024

NARRATIVE

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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.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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/inspection-process.

A Type B Deficiency is being cited based on LPAs' observation/interviews/record reviews pursuant to Title 22 of the CA Code of Regulations and HSC 1596.8662(b)(1) (refer to LIC 809-D). Licensee was provided a copy of their appeal rights (LIC 9058) and their signature on this form acknowledges receipt of these rights.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Facility representative Kayleen Barger.

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Elvin Baddley
LICENSING EVALUATOR SIGNATURE:	DATE: 09/30/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2024

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 10/01/2024 05:56 PM - It Cannot Be Edited

Created By: Elvin Baddley On 09/30/2024 at 05:06 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
, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: KCE CHAMPIONS LLC @ VINEYARD ELEMENTARY	FACILITY NUMBER: 406215807
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/30/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1596.8662(b)(1)

(1) On or before March 30, 2018, a person who, on January 1, 2018, ... licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training ...shall training every two years following... This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation/interview/record review, the licensee did not comply with the section cited above in that S1's Mandated Reporter Training Certificate expired on 7/20/23, which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 10/14/2024
	Plan of Correction
1 2 3 4	Administrator to submit Mandated Reporter Certification for S1 to CCLD (elvin.baddley@dss.ca.gov) by the close of business (5:00 PM) on 10/14/24.

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:

Maria Mueller

LICENSING EVALUATOR NAME:

Elvin Baddley

LICENSING EVALUATOR SIGNATURE:

DATE: 09/30/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2024

LIC809 (FAS) - (06/04)

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