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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376701382
Report Date: 06/05/2023
Date Signed: 06/05/2023 03:31:28 PM

Document Has Been Signed on 06/05/2023 03:31 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, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME:KCE CHAMPIONS LLC AT KAVODFACILITY NUMBER:
376701382
ADMINISTRATOR:ALEXIA MORALESFACILITY TYPE:
840
ADDRESS:6991 BALBOA AVENUETELEPHONE:
(858) 221-3744
CITY:SAN DIEGOSTATE: CAZIP CODE:
92111
CAPACITY: 140TOTAL ENROLLED CHILDREN: 90CENSUS: 66DATE:
06/05/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Alexia MoralesTIME COMPLETED:
03:45 PM
NARRATIVE
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On June 5, 2023 at 12:00 p.m. Licensing Program Analyst (LPA) Leilani Curtis visited the facility to conduct an annual inspection. Upon arrival LPA met with Site Director Alexia Morales and proceeded to tour the facility. LPA provided the LIC 125, Entrance Checklist to Director Morales. There were 66 children present with 6 staff members. Appropriate ratios and capacity were observed. Staff members have the required background clearances and are associated to the facility. No excluded individuals are present. The licensee has not exceeded the approved capacity of the fire clearance for the facility.

LPA observed that furniture and age-appropriate equipment is in good condition indoors and outdoors. Children's toilets and hand washing facilities are sanitary. Rooms are safe and clean. The food preparation area is clean. Food and beverages are stored in covered containers at 45 degrees F or less if required, and storage containers for solid waste are covered. Drinking water is readily accessible inside and outside the classroom. Bathrooms are maintained with operational toilets and faucets with appropriate temperature. All disinfectants, cleaning solutions, and other hazardous items are inaccessible to children. Storage area for poisons is locked. The outdoor play area is fenced. Playground equipment is in safe condition, free of sharp, loose or pointed parts. The areas around or under high climbing equipment, swings, slides, and similar equipment is cushioned with material that absorbs a fall. The outdoor play area has canopies and umbrellas used for shade. There are no bodies of water or weapons at this facility. The facility does not have disaster/fire drill documentation which meet regulation requirements available for review. There is an operational carbon monoxide detector at the facility. First Aid/CPR certifications were reviewed and are in compliance. Medications are kept in a safe place inaccessible to children.
SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Grace Curtis
LICENSING EVALUATOR SIGNATURE: DATE: 06/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/05/2023
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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Document Has Been Signed on 06/05/2023 03:31 PM - It Cannot Be Edited


Created By: Grace Curtis On 06/05/2023 at 02:38 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
, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108

FACILITY NAME: KCE CHAMPIONS LLC AT KAVOD
FACILITY NUMBER: 376701382

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/05/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101174(d)(2)
Disaster and Mass Casualty Plan
(d) Disaster drills shall be conducted at least every six months. (2) The drills shall be documented. This documentation shall be kept in the child care center for at least one year.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above. The licensee does not have disaster/fire drill documentation available for review. This poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/16/2023
Plan of Correction
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The director states that she will conduct and document a disaster/fire drill. The director also states that she will send LPA a copy of the disaster/fire drill documentation via email by 6/16/23.
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:Tashima Daniel
LICENSING EVALUATOR NAME:Grace Curtis
LICENSING EVALUATOR SIGNATURE:
DATE: 06/05/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/05/2023


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
CCLD Regional Office, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME: KCE CHAMPIONS LLC AT KAVOD
FACILITY NUMBER: 376701382
VISIT DATE: 06/05/2023
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Admission agreement, emergency information and medical assessment forms were reviewed for some children. Sign in/sign out sheets were reviewed and are well maintained. Staff records contain documentation of education, training, and/or experience. Menus are posted. The director states that a water sample was taken from the facility on 12/10/22 for lead testing. LPA obtained an updated Emergency Disaster Plan for Child Care Centers- LIC610, Personnel Report-LIC500 and a copy of the water testing report.

This facility provides Incidental Medical Services – IMS. The director states that there are currently no children enrolled who required these services. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226.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: http://www.ada.gov/childqanda.htm.

See LIC809D for cited deficiency.

Child Care Providers can now sign up for Quarterly Updates and PINS through the DSS website. Please go to www.ccld.ca.gov and click on Child Care, go under Quick Links and Quarterly Updates, click on “Receive Important Updates” then enter your email address and choose which program(s) you would like to subscribe to and click “subscribe”.

Duty Officer: (619) 767- 2248, Monday thru Friday 8am-5pm.

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.

Director Morales was reminded that all adults 18 and over, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with Director Morales.

SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Grace Curtis
LICENSING EVALUATOR SIGNATURE:

DATE: 06/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/05/2023
LIC809 (FAS) - (06/04)
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