434415370-4-20-2023-07-CC-FRAA-CR3M9W-20230420092525

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434415370
Report Date: 04/10/2023
Date Signed: 04/20/2023 09:25:38 AM

Document Has Been Signed on 04/20/2023 09:25 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
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME:	KCE CHAMPIONS LLC @ LEDESMA ELEMENTARY - PS		FACILITY NUMBER:	434415370
ADMINISTRATOR:	HELEN DE LA CRUZ		FACILITY TYPE:	850
ADDRESS:	1001 SCHOOLHOUSE ROAD		TELEPHONE:	4087079381
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95138
CAPACITY: 24	TOTAL ENROLLED CHILDREN: 16	CENSUS: 0	DATE:	04/10/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:40 AM
MET WITH:	Ilse Richter		TIME COMPLETED:	01:30 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	Licensing Program Analysts (LPAs), Farida Raja and Anna Morales, met with Site Director, Ilse Richter, for an unannounced Required 1-Year inspection in the Preschool Program. The facility is licensed to serve children ages 3-5 years in two portable rooms located on the Ledesma Elementary School campus. LPA observed the required posted materials including menus and daily activity schedule. Days and hours of operation are Monday through Friday, 8:30 am to 12:00 pm. Upon arrival, LPAs observed no preschool children as the preschool program was closed for Spring Break. Two (2) portable classrooms are used for the Preschool Program until 12pm and the same two classrooms are used for the School Age Program from 1:30-5:30 pm. LPAs toured the indoor and outdoor areas of the Preschool Program during today's inspection. The classrooms, children's restrooms and kitchen/storage area were inspected. The disinfectants, cleaning solutions or chemicals that are dangerous to the health and safety of children were stored in a closed room and were inaccessible to children. Furniture and equipment were age appropriate and in good condition, free of sharp, loose, or pointed parts. Restrooms for children were observed to be in safe, sanitary, and functioning condition. Floors were clean and free from tripping hazards. Drinking water is readily available for the children in each room and in the outdoor playground area via individual water bottles. LPA observed solid waste containers with tight-fitting lids in the rooms. Director states that there are no weapons or firearms on the premises. There is a working telephone in the facility. LPA observed 2 fire extinguishers and fire pull stations. The facility has built in smoke detector/ fire system. Log shows that the last Fire Drill was conducted on 03/08/2023 which is compliant with the six-month requirement for facilities. Facility does not provide transportation to children, but Director understands that children cannot be left alone, unattended in parked vehicles. Continued on Page 2

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Farida Raja
LICENSING EVALUATOR SIGNATURE:	DATE: 04/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/10/2023

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: KCE CHAMPIONS LLC @ LEDESMA ELEMENTARY - PS	FACILITY NUMBER: 434415370
	VISIT DATE: 04/10/2023

NARRATIVE

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Foods and beverages were stored safely in the kitchen area. Food storage and preparation areas were observed to be sanitary. All food and beverages that require refrigeration are stored in covered containers. The facility only offers morning snack for the half day preschool program. All snacks were observed to be kept in labelled containers with expiration dates marked on the front. The menu is in writing and posted at least one week in advance, accessible to authorized representatives. LPA's advised that snack menu should have portion sizes for food served. Medications were stored in the kitchen area in high cabinets and inaccessible to children.

Outdoor playground and play equipment was inspected and observed to be free of hazards. Preschool program children use the kindergarten playground. LPAs observed play equipment was in good condition, age-appropriate, and has sufficient resilient materials to absorb falls. Shade is provided by building overhang. There were no bodies of water observed.

Children sign in and out procedures and logs were reviewed. Children's Roster was reviewed and a copy was provided to the LPAs. A sampling of 6 children's files and 2 staff files were reviewed. All children's and staff files were complete with all required documentation.

All teacher files were reviewed contain the required transcripts/verification of experience. At least one staff member on site has a current CPR and First Aid certification on file. Director understands that there shall be at least one person, with valid CPR and First Aid certifications, on site at all times or present during off-site activities (field trips). All staff have the required Immunization's against Pertussis, Measles and Influenza Declination letter. LPAs also observed the required Mandated Reporter Training on file for all staff. LPA's reminded both training's must be renewed every 2 years.

Director stated that facility does handle medications but currently has no children in care who require medications or IMS. LPA reviewed storage of medication and equipment / supplies. Isolation of sick child was discussed, and Director explained that a sick child is either isolated in a separate classroom or near the front desk to wait for parents. Child is always under visual supervision while in care of the facility.

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SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Farida Raja
LICENSING EVALUATOR SIGNATURE:	DATE: 04/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/10/2023

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 JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: KCE CHAMPIONS LLC @ LEDESMA ELEMENTARY - PS	FACILITY NUMBER: 434415370
	VISIT DATE: 04/10/2023

NARRATIVE

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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 Americans with Disabilities Act (ADA) was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) & link to Commonly Asked Questions and the ADA, available at:<http://www.ada.gov/childqanda.htm>

LPA reminded Director of the applicable civil penalties for those adults who have not received fingerprint clearances, are not associated to the license, and who come in contact with or provide care and supervision to the children. For an initial violation, civil penalty amounts to $100.00 per person per day with a maximum of $500.00 per person. For a subsequent violation within a 12-month period, civil penalty amounts to $100.00 per person per day with a maximum of $3000.00 per person. LPA also reviewed with Director the violations that would result in an immediate assessment of civil penalty in the amount of $500. Director is encouraged to visit the Department’s website at www.ccld.ca.gov to access resources for Providers, Title 22 Regulations, Online option to pay Annual License fee, Adoption of new Laws, etc.

Exit interview conducted and report was reviewed with the Site Director, Ilse Richter.

As a result of today's inspection, there were no deficiencies cited.

A NOTICE OF SITE VISIT WAS GIVEN AND MUST REMAIN POSTED FOR 30 CONSECUTIVE DAYS

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.

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Farida Raja
LICENSING EVALUATOR SIGNATURE:	DATE: 04/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/10/2023

LIC809 (FAS) - (06/04)

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