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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364844050
Report Date: 08/20/2024
Date Signed: 08/20/2024 04:38:13 PM

Document Has Been Signed on 08/20/2024 04:38 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
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:KCE CHAMPIONS LLC@ PARK VIEW PREPARATORYFACILITY NUMBER:
364844050
ADMINISTRATOR/
DIRECTOR:		TATE JANE, TRACYFACILITY TYPE:
840
ADDRESS:13427 CAHUENGA ROADTELEPHONE:
(760) 713-0443
CITY:VICTORVILLESTATE: CAZIP CODE:
92392
CAPACITY: 56TOTAL ENROLLED CHILDREN: 56CENSUS: 43DATE:
08/20/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:10 PM
MET WITH:Elizabeth RamirezTIME VISIT/
INSPECTION COMPLETED:
04:30 PM
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On August 20, 2024, Licensing Program Analyst (LPA) Calloway made an unannounced inspection to the above facility for the purpose of conducting a Required Annual Random inspection. LPA met with facility representative who granted access. LPA and representative toured the facility inside and outside. LPA observed forty-three (43) active children in care and four (4) representatives. The facility operates from 6:00 am to 8:00 AM for morning and 2:00 PM to 6:30 PM for evening. Monday through Thursday and Fridays are: 12:00 PM to 6:30 PM. There are two separate classrooms one for TK- 2nd grade and the other for 3rd -6th grade. This is a before and after school facility. All representatives have criminal record clearance and are associated to the facility.
Physical Plant: LPA observed two clean and safe classrooms, telephone service, heating, lighting, and ventilation are adequate. There are cubbies for children's belongings that were not labeled in each classroom. Furniture, books, equipment, toys, and materials were age appropriate. Drinking water is available inside the classrooms in the form of water dispensers and disposable cups. A water lead test was conducted and none of the children are drinking from the faucets. There is no napping. One classroom has a first aid backpack kept in hanging in the classroom. The other classroom the First Aid Kit was observed inside the kitchen on the wall. There is not an Emergency Survival Kit Bin, but per representative, there are blankets, food, and water enough for three days inside the classroom.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Kuliema Calloway
LICENSING EVALUATOR SIGNATURE: DATE: 08/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/15/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: KCE CHAMPIONS LLC@ PARK VIEW PREPARATORY
FACILITY NUMBER: 364844050
VISIT DATE: 08/20/2024
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There were three Fire extinguishers that were full and green, last serviced 3/19. LPA observed a fire alarm pull switch and sprinkler system inside the ceiling. The smoke detector and carbon monoxide detector were not tested. Trash cans did not have secure lids.
Bathrooms: LPA inspected the children's bathroom. There is one bathroom inside each classroom that is shared. Staff has one stall, and children have one stall that are labeled. There is two toilets and one handwashing sink inside each restroom. Per representative, there are no other available restroom on the school campus for use. The toilets and sinks are functioning properly and age appropriate there was storage inside each staff stall, LPA did not observe any hazards or chemicals. LPA observed soap, toilet paper, and paper towels readily available.
Kitchen: There is a fully equipped kitchen with refrigerator, stove, oven, microwave, and sink. The facility provides morning and afternoon snacks. Menus are posted. LPA observed allergy list on the medicine cabinet inside the kitchen. LPA observed an appropriate amount of food and snacks. The chemicals are not kept separate from the food. Cleaning supplies are kept under the sink inside the kitchen, there was no safety latch. LPA observed 1% milk for the children.
Outside: Outdoor play equipment was inspected for health, safety, cushioning material, good repair and is age appropriate. LPA observed a large play structure with sand as a cushioned surface and securely anchored. There are tether ball, handball, and basketball courts. The playground was observed to be free of debris. Drinking water is available in the form of a water fountain. There are no bodies of water on the premises. Other: Children and staff files were reviewed. Current Pediatric CPR and First Aid Expires: 10/29/24. Transportation is provided, and medical policy reviewed. Disaster Drills: Fire: last drill was conducted 7/2024. Earthquake has not been conducted. The Roster of student’s names is current. Children are inspected for illnesses as they arrive.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Kuliema Calloway
LICENSING EVALUATOR SIGNATURE:

DATE: 08/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2024
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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
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: KCE CHAMPIONS LLC@ PARK VIEW PREPARATORY
FACILITY NUMBER: 364844050
VISIT DATE: 08/20/2024
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There is a separate area for isolation and care of ill children on a cot separate from the other children. Staff/child ratios were observed to be compliant, sign in/out sheets were observed on paper. Facility representative was reminded to access the Licensing website at www.ccld.ca.gov. to obtain information about the most recent regulatory changes and the Quarterly Updates. Medications are stored inside a locked cabinet in the kitchen. A review of medication policy indicated that prescription medication is administered only with parent's written permission. The management staff administers medication and documents the dosage, date, and time onto a log. Medication is stored in the locked cabinet. Medication is properly labeled and stored in its original container.
Facility representative was reminded that all adults 18 and over, 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 Childcare 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.
Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-
CCP. When any IMS is provided, an updated Plan of Operation that includes 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) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Childcare Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/. Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Childcare Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5 years after the date of the first test.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Kuliema Calloway
LICENSING EVALUATOR SIGNATURE:

DATE: 08/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2024
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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
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: KCE CHAMPIONS LLC@ PARK VIEW PREPARATORY
FACILITY NUMBER: 364844050
VISIT DATE: 08/20/2024
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For childcare center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1-CCP). Or LPA referred facility representative to the Department website for lead: Lead Toxicity Prevention and Water Testing Information. Lead Poisoning: For more information, go to the California Childhood Lead Poisoning Prevention Branch’s website at www.cdph.ca.gov/programs/clppb,or call them at (510) 620-5600.
Facility representative was informed of the MyChildCarePlan.org website, a
consumer education website that helps families obtain childcare by connecting them to childcare 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.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platforms. To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-carelicensing/
subscribe and select the Childcare option to receive email communication.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Kuliema Calloway
LICENSING EVALUATOR SIGNATURE:

DATE: 08/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2024
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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
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: KCE CHAMPIONS LLC@ PARK VIEW PREPARATORY
FACILITY NUMBER: 364844050
VISIT DATE: 08/20/2024
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The On Duty Worker is available for questions Monday through Friday at (661) 202-3318 from 8:00 AM - 5:00 PM for questions, information, and Unusual Incident Reporting.

Per Title 22 Regulations, Division 12, Chapter 1, there is one deficiency cited during this inspection. There are Technical Advisories issued. See 809 D page and TA pages attached to this report.

Exit interview was conducted and a copy of this report was read, a Notice of Site Visit, and this report, were provided to Elizabeth Ramirez, Facility Representative. A Notice of Site Visit must remain posted for thirty (30) consecutive days. Failure to maintain posting will result in a $100 civil penalty.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Kuliema Calloway
LICENSING EVALUATOR SIGNATURE:

DATE: 08/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 08/20/2024 04:38 PM - It Cannot Be Edited


Created By: Kuliema Calloway On 08/20/2024 at 04:25 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
, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: KCE CHAMPIONS LLC@ PARK VIEW PREPARATORY
FACILITY NUMBER: 364844050

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/20/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101515(b)
School-Age Child Care Center Director Qualifications and Duties
(b) All school-age child care centers shall have a director.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, and record review, the licensee did not comply with the section cited above in the newly appointed site director's paperwork was not submitted to the Licensing office within 10 days of the change of appointment which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/25/2024
Plan of Correction
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New Site Director will submit the packet of information to Licensing for review by POC date.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Claretta Yates
LICENSING EVALUATOR NAME:Kuliema Calloway
LICENSING EVALUATOR SIGNATURE:
DATE: 08/20/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/20/2024


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