434417042-8-15-2023-07-CC-PHEZ-CUQRME-20230815130838

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434417042
Report Date: 08/15/2023
Date Signed: 08/15/2023 01:08:45 PM

Document Has Been Signed on 08/15/2023 01:08 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
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME:	KCE CHAMPIONS LLC @ DILWORTH ELEMENTARY		FACILITY NUMBER:	434417042
ADMINISTRATOR:	LUCY GANNER		FACILITY TYPE:	840
ADDRESS:	1101 STRAYER DRIVE		TELEPHONE:	(408) 386-5745
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95129
CAPACITY: 120	TOTAL ENROLLED CHILDREN: 120	CENSUS: 0	DATE:	08/15/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:15 AM
MET WITH:	Elaine Jane Ongolea		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	LPA met with Elaine Jane Ongolea, facility Director, and explained the reason for the inspection. The purpose of this inspection is to conduct a Required 1 Year Inspection of , KCE Champions LLC for the school-age license with a capacity of 120, serving ages 4.9 to 14 years old. Facility is located on the Dilworth Elementary campus in Room 22 and Room 23. A fire clearance for 120 was granted on 06/07/2022. There were no children Present because the program does not open until 8/17/23. Room 22 had 2 Teachers. Room 23 had 1 and Teacher/Director. LPA toured the Facility both inside and outside during today's visit. LPA notes that the Facility is licensed but currently only has 2 School Age rooms in use: Rooms 22 and 23. The playground is in good condition with shock absorbing material under the climbing equipment. LPA observed the required posted materials, Elaine Jane Ongolea including the Facility License, Emergency Disaster Plan (LIC 610), Earthquake Preparedness Checklist (LIC 9148), Parents' Rights Poster (PUB 393), Personal Rights (LIC 613A), Child Car Seat Law (PUB 269), Menu, and Activity Schedule. The facility . Elaine Jane Ongolea provided a copy of the fire drill record with last entry dated 4/4/2023. The sign in and out records and the children's roster were provided to the LPA. LPA reviewed 5) Ten children's files. Each child's file reviewed contains the required information. LPA reviewed 5 staff files. The required Mandated Reporter Training (AB1207) and the required immunization's against Pertussis, Measles, and Influenza (or opt out letter). There is at least one teaching staff member that has current CPR and First Aid certifications on file. DIrector's First Aid and CPR expires 2/11/25. Director understands that there shall be at least one person, with valid CPR and First Aid certifications. There were 0 preschool children present during today’s inspection. However, Director understands the conditions, limitations, and capacity specifications of the Facility license. Director understands that children shall be visually supervised at all times. REPORT CONTINUED ON THE FOLLOWING PAGE (REPORT DATED 0815/2023:

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Pietro Hernandez
LICENSING EVALUATOR SIGNATURE:	DATE: 08/15/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2023

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 @ DILWORTH ELEMENTARY	FACILITY NUMBER: 434417042
	VISIT DATE: 08/15/2023

NARRATIVE

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CONTINUATION OF PREVIOUS PAGE (REPORT DATED 08/15/23):
LPA reminded the Director was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. 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.

LPA observed that the room is clean and safe for all children and staff. Katherine states that the schools custodial team cleans the preschool rooms Monday through Friday in the evenings during the school year. Drinking water is readily available for the children inside via two water fountains and outside via personal water bottles. LPA observed solid waste containers with tight-fitting lids in the classrooms. Children's bathrooms are clean, sanitary, and operable. There is a separate staff bathroom not utilized by the children which an isolated child can use if needed. Katherine states that there are no weapons or firearms on the premises.

The Preschool provides AM and PM snacks and though most of the children bring their lunch from home, the school does offer a hot lunch, from the on site school cafeteria, upon request by the parent. The food preparation and storage areas are clean, free of litter & rubbish, and free of rodents and other vermin. Cleaning supplies are inaccessible to the children and stored in locked cabinets inaccessible to children. Any medications at the Facility are stored in the Directors office. LPA observed a Fire Drill log with the last fire drill being conducted on 4/4/2023.

LPA observed all furniture and equipment is in good condition and safe for the children. The playground area utilized by children is surrounded by appropriate fencing and the outdoor surfaces are safe for the children. LPA observed that the outdoor equipment is age appropriate and in good condition. The resilient shock absorbent materials in the outdoor playground area are sufficient. LPA did not observe any bodies of water.
LPA provided the Community Care Licensing’s website www.ccld.ca.gov, so the licensee can obtain updated licensing information, new regulations and access forms. LPA advised the licensee of their responsibility to stay current in regard to new regulations. LPA also provided the e-mail address for the advocates in order to be added to the quarterly newsletter mailing list childcareadvocatesprogram@dss.ca.gov. LPA discussed Assembly Bill (AB) 2370 and gave Lead Safety information.

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Pietro Hernandez
LICENSING EVALUATOR SIGNATURE:	DATE: 08/15/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2023

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 @ DILWORTH ELEMENTARY	FACILITY NUMBER: 434417042
	VISIT DATE: 08/15/2023

NARRATIVE

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CONTINUATION OF PREVIOUS PAGE (REPORT DATED 08/15/2023):

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02- CCP. When any IMS is provided, a Plan for Providing 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: https://www.ada.gov/resources/child-care-centers/.

Licensee 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.

During the exit interview, the Licensee confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

LPS/s discussed the requirements of AB 633 with the Licensee/Director Elaine Jane Ongolea and provided the AB 633 fact sheet and a copy of Acknowledgement of Receipt of Licensing Reports (LIC 9224) and the Licensee/Director understands the requirements. Upon receipt, Licensee/Director Katheryn Muniz shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months.

Upon the issuance of Type A citations, a copy of the Facility Evaluation Report LIC809 has to be posted on the wall and a copy to be given to all parents of currently and newly enrolled children for next 12 months. In addition, copy of LIC9224 Statement Acknowledging Receipt of Licensing Reports need to be signed and kept in child files.

Exit interview conducted and report was reviewed with the Licensee, Elaine Jane Ongolea.

NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE ENTRANCE TO THE FACILITY, AND MUST REMAIN POSTED FOR 30 DAYS.

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Pietro Hernandez
LICENSING EVALUATOR SIGNATURE:	DATE: 08/15/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2023

LIC809 (FAS) - (06/04)

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