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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376701382
Report Date: 01/09/2024
Date Signed: 01/09/2024 11:14:12 AM

Document Has Been Signed on 01/09/2024 11:14 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 DIEGO N. CC RO, 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: 0DATE:
01/09/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Alexia Morale TIME COMPLETED:
11:30 AM
NARRATIVE
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On 1/9/24 at 10:45 AM Licensing Program Analyst (LPA), Gerald Poindexter conducted an unannounced secondnd case management visit to follow-up on an 11/2/23 incident involving a teacher grabbing a student’s arm. LPA met with Director Alexia Morales.

During the visit the LPA reviewed details of the incident and discussed the LPA’s follow up activities related the incident.

See 809D for deficiencies cited.

Exit interview conducted with the director Alexia Morales.

Notice of site visit was given, and it must remain posted for 30 days.

SUPERVISORS NAME: Joelle Redding
LICENSING EVALUATOR NAME: Gerald Poindexter
LICENSING EVALUATOR SIGNATURE: DATE: 01/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/09/2024
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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Document Has Been Signed on 01/09/2024 11:14 AM - It Cannot Be Edited


Created By: Gerald Poindexter On 01/09/2024 at 10:57 AM
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: 01/09/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/09/2024
Section Cited
CCR
101223(a)(3)

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(a) The licensee shall ensure that each child is accorded the following personal rights:
(3) To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse or other actions of a punitive nature…
This requirement is not met as evidenced by:
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Director, Alexia Morales, states the incident was reviewed internally and S1 was terminated. Also, on 11/10/23, there was a previously scheduled staff meeting attended by Kovod & KCE Champions branches. Child behavior and staff responses was reviewed and reinforced at that meeting. .
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Based on staff interviews and video provided by the facility, S1 physically grabbed and held C1 multiple times while attempting to retrieve play equipment. This posed a potential health, safety or personal rights risk to the children in care.
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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:Joelle Redding
LICENSING EVALUATOR NAME:Gerald Poindexter
LICENSING EVALUATOR SIGNATURE:
DATE: 01/09/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/09/2024


LIC809 (FAS) - (06/04)
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