406206847-8-28-2023-17-CC-EBAY-CV5RTB-20230828131805

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 406206847
Report Date: 08/28/2023
Date Signed: 08/28/2023 01:18:26 PM

Document Has Been Signed on 08/28/2023 01:18 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 BENITO		FACILITY NUMBER:	406206847
ADMINISTRATOR:	DAWN MARTIN		FACILITY TYPE:	840
ADDRESS:	4300 SAN BENITO		TELEPHONE:	(805) 975-6105
CITY:	ATASCADERO	STATE: CA	ZIP CODE:	93422
CAPACITY: 58	TOTAL ENROLLED CHILDREN: 58	CENSUS: 3	DATE:	08/28/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:46 AM
MET WITH:	Kristin Elliott		TIME COMPLETED:	12:45 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	On 8/28/23, at 10:46 AM, Licensing Program Analyst (LPA) Elvin Baddley conducted an unannounced One Year Required Annual inspection of the abovementioned Child Care Center (CCC). LPA met with Kristin Elliot, Site Supervisor of the CCC and explained the purpose of the inspection. LPA, in the company of the Site Supervisor, toured the interior and exterior of the CCC. The CCC is located in a classroom on the grounds San Benito Elementary School. The CCC operates from 7:00 AM to 6:00 PM, Monday thru Friday. The CCC has an AM program on site from 7:00 AM to 8:20 AM and a PM program on site from 2:30 PM to 6:00 PM. Additionally, a TK program is on site from 11:30 AM to 2:30 PM. LPA observed 3 children in care during the inspection along with two teacher (cleared and associated) providing care and supervision. The CCC classroom has age appropriate equipment and furnishings available to children in care. LPA observed a carbon monoxide detector in the CCC which was tested at 10:55 AM and found to be operable. The bathrooms used by the children, on the grounds of the elementary school, are in safe and sanitary operating condition. LPA observed an operable refrigerator in the classroom room which contains food for the children. The CCC provides morning and mid day snacks for the children. LPA observed a CCC menu posted. Children have available drinking water inside of the CCC and out. The water source comes from building fountains and bottle water. Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care 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. For child care 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). LPA verified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP. Disinfectants, cleaning solutions, medications and sharps are in location inaccessible to children in care. LPA reviewed the CCC's Sign In/Out forms for children and notes the forms contain the children's arrival and (CONT. LIC 809-C, Page 2)

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Elvin Baddley
LICENSING EVALUATOR SIGNATURE:	DATE: 08/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2023

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
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: KCE CHAMPIONS LLC @ SAN BENITO	FACILITY NUMBER: 406206847
	VISIT DATE: 08/28/2023

NARRATIVE

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exit times as well as the signature of the children's authorized representatives. LPA observed required licensing notices and documents posted on the wall near the entry/exit door of the CCC.

The CCC's outdoor playground area is enclosed by chain linked and footing in the area is varied. LPA observed age appropriate play equipment in the play areas. The play equipment are free of sharp, loose or pointed objects. The play structures in the playground area have adequate cushioning materials (wood chips) to absorb falls. Two sheds are in the play area which are secure and contain elementary school supplies. No bodies of water are observed on site. LPA notes the outdoor play area is shared with the elementary school's classrooms. Site Supervisor informed LPA the CCC's children play in the play area at times different (staggered) than the elementary school students.

A sampling of staff and children's records are reviewed. The children’s records are complete and found to contain emergency contact information and admission agreements. Staff records are reviewed and contained documentation to support their educational training and experience. LPA also observed current pediatric CPR/ First Aid (EMSA approved) certifications along with Mandated Reporter training certifications. Site Supervisor noted no firearm or ammunition is stored on site.

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of “medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see PIN 22-02-CCP. 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 Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/.

Facility representative was reminded that all adults 18 and over responsible for administration or direct supervision of staff, persons who provides care and supervision to children, and staff who have contact with children, 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 Child Care 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.
(CONT. 809-C, Page 3)

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Elvin Baddley
LICENSING EVALUATOR SIGNATURE:	DATE: 08/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2023

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, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: KCE CHAMPIONS LLC @ SAN BENITO	FACILITY NUMBER: 406206847
	VISIT DATE: 08/28/2023

NARRATIVE

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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.

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 Kristin Elliott.

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Elvin Baddley
LICENSING EVALUATOR SIGNATURE:	DATE: 08/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2023

LIC809 (FAS) - (06/04)

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