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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 406206847
Report Date: 10/19/2023
Date Signed: 10/19/2023 04:53:31 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/21/2023 and conducted by Evaluator Elvin Baddley
COMPLAINT CONTROL NUMBER: 17-CC-20230821120635
FACILITY NAME:KCE CHAMPIONS LLC @ SAN BENITOFACILITY NUMBER:
406206847
ADMINISTRATOR:DAWN MARTINFACILITY TYPE:
840
ADDRESS:4300 SAN BENITOTELEPHONE:
(805) 975-6105
CITY:ATASCADEROSTATE: CAZIP CODE:
93422
CAPACITY:58CENSUS: 24DATE:
10/19/2023
UNANNOUNCEDTIME BEGAN:
03:15 PM
MET WITH:Kristin ElliotTIME COMPLETED:
04:05 PM
ALLEGATION(S):
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1. Staff are operating out of ratio
INVESTIGATION FINDINGS:
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On 10/19/23, Licensing Program Analyst (LPA) Elvin Baddley made an unannounced inspection to the abovementioned Child Care Center (CCC) to deliver a finding with respect to an alleged violation of the CCC operating outside of ratio. LPA met with Kristin Elliot, the CCC's site supervisor, and explained the purpose of the visit. LPA, in the company of the site supervisor toured the interior and exterior of the CCC. LPA observed 24 children in care at the time of the inspection along with two staff members providing care and supervision. It should be noted Site Supervisor is assisting with the care and supervison of children in care.

The investigation included three site inspections, interviews with the Site Supervisor and the parents of children in care. The Complainant was anonymous, thus a formal interview of the Complainant was not conducted, Pertinent documents were also reviewed by the LPA.

Interviews, document reviews as well as LPA's observations did not corroborate the allegation noted above. (CONT. 9099-C, Page 2)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Elvin Baddley
LICENSING EVALUATOR SIGNATURE:

DATE: 10/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 17-CC-20230821120635
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: 10/19/2023
NARRATIVE
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Unannounced inspections revealed the facility was operating within the ratios mandated by the regulation of a school aged program.

This agency has investigated the Complaint alleging the CCC is operating out of ratio. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Exit interview conducted and report was reviewed with the Facility representative Kristin Elliot.


A Notice of Site Visit (LIC 9213) and Appeal Rights (LIC 9058) were provided to the Site Supervisor. The Notice of Site Visit must remain posted for 30 days or a civil penalty of $100.00 may apply.
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Elvin Baddley
LICENSING EVALUATOR SIGNATURE:

DATE: 10/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2