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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 406206845
Report Date: 07/02/2024
Date Signed: 07/02/2024 03:11:02 PM

Document Has Been Signed on 07/02/2024 03:11 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, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME:KCE CHAMPIONS LLC @ SAN GABRIELFACILITY NUMBER:
406206845
ADMINISTRATOR/
DIRECTOR:
TAMARA PAYNE-ALEXFACILITY TYPE:
840
ADDRESS:8500 SAN GABRIELTELEPHONE:
(805) 975-8429
CITY:ATASCADEROSTATE: CAZIP CODE:
93422
CAPACITY: 50TOTAL ENROLLED CHILDREN: 50CENSUS: 31DATE:
07/02/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:45 PM
MET WITH:Nevaeh HintonTIME VISIT/
INSPECTION COMPLETED:
03:15 PM
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On 7/2/24, at 1:45 PM, Licensing Program Analysts (LPAs) Elizabeth George and Elvin Baddley conducted an unannounced Case Management Inspection at the abovementioned Child Care Center (CCC) to address an Unusual Incident Report (UIR) received by the Department on 6/18/24. The incident involved a child (C1) in care leaving the CCC and being trailed by a staff member, which ultimately left the facility operating outside of staff to child ratio for 15-18 minutes.

LPAs met with Nevaeh Hinton, acting Site Supervisor of the CCC, and explained the nature and purpose of the inspection. LPAs toured the interior and exterior of the CCC and observed 31 children present along with five teachers providing care and supervision.

Site Supervisor discussed the incident with LPAs. Site Supervisor informed LPAs the CCC was operating within the staff to children ratio prior to C1 wondering off from the CCC's classroom. Site Supervisor also noted the CCC was operating outside of ratio (1 staff to 20 children) for about 15-18 minutes, before an additional staff member arrived on site. Site Supervisor noted the CCC would have had an appropriate level of staff to children on site had a staff member not arrived late on the given date. Site Supervisor informed LPAs the CCC had been operating two weeks prior to the incident and staff members were aware C1 had a tendency to wonder from the classroom. It should be noted C1 is not longer attending the CCC and C1's caregiver reportedly expressed the CCC's program was not "a good fit" for the child.

Given the LPAs’ observations, along with interviews and record reviews, it is determined the children at the CCC were not placed at risk given the CCC operating outside of ratio for a brief period of time. Moreover, the staff to child ratio was only compromised given an exigent circumstance of a child wondering. The wondering child was addressed without incident and the children who remained in the classroom with the single staff member were not jeopardized.

No deficiencies were cited during today's inspection. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Facility Representative Nevaeh Hinton.
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Elvin Baddley
LICENSING EVALUATOR SIGNATURE: DATE: 07/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/02/2024
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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