406215806-10-4-2024-17-CC-EBAY-D9QSNK-20241004140141

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 406215806
Report Date: 10/04/2024
Date Signed: 10/04/2024 02:01:49 PM

COMPREHENSIVE INSPECTION

Document Has Been Signed on 10/04/2024 02:01 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 @ TEMPLETON ELEMENTARY		FACILITY NUMBER:	406215806
ADMINISTRATOR/ DIRECTOR:	DAWN MARTIN		FACILITY TYPE:	840
ADDRESS:	215 EIGHTH STREET		TELEPHONE:	(408) 348-1610
CITY:	TEMPLETON	STATE: CA	ZIP CODE:	93465
CAPACITY: 75	TOTAL ENROLLED CHILDREN: 75	CENSUS: 18	DATE:	10/04/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	11:40 AM
MET WITH:	Madison Sellers		TIME VISIT/ INSPECTION COMPLETED:	02:15 PM

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On 10/4/24, at 11:40 AM, Licensing Program Analyst (LPA) Elvin Baddley conducted an unannounced Annual/Random inspection of the abovementioned Child Care Center (CCC). LPA met with Madison Sellers, Lead Teacher of the CCC. LPA explained the purpose and nature of the inspection. The facility is located on the grounds of Templeton Elementary School. The school-age program operates from 7:55 AM to 5:30 PM Monday – Friday. The CCC is divided into three sessions. Session 1 is from 7:55 AM to 11:30 AM. Session 2 is from 11:30 AM to 2:30 PM, while Session 3 is from 2:30 PM to 5:30 PM. The CCC uses two classroom (L-3 and L4) for child care services. At the time of inspection, LPAs observed 18 children on site, along with four teachers.

The classrooms of the CCC are clean and orderly. The classrooms have age appropriate equipment and furnishings available to children in care. Disinfectants, cleaning solutions and sharps are observed in locations accessible to staff members but inaccessible to children in care. The CCC's carbon monoxide detector was not tested by LPA as the CCC's carbon monoxide detector is integrated in the elementary school's fire detection's system. LPA was informed the elementary school's fire detection system is regularly tested and monitored by school service personnel. LPA observed required licensing forms and documents posted near the main door entry of both rooms. A menu is also posted in a visible location in the classroom (L-3). The CCC's Sign In/Out forms are located in a binder and are reviewed by LPA. The forms contained the arrival and departure times of children in care and well as the signatures of the children's authorized representatives.

The CCC uses a total of four restrooms for children in care. All restrooms used by the children are observed to be in safe and sanitary operating condition. The CCC shares the restrooms with other children in the elementary school, however CCC children are monitored by CCC staff when using the restrooms. LPA observed an operable mini refrigerator in the classroom (L-4) which contained food for the children. The CCC provides morning and afternoon snacks to children in care. Lunch is provided by the elementary school. Children also have the option to bring their lunches from home. The CCC has available filtered drinking water for children inside and outside of the facility. CCCs constructed before 1/1/20, to test their water (used for drinking and food preparation) for lead contamination before 1/1/23, and (CONT. LIC 809-C, Page 2)

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Elvin Baddley
LICENSING EVALUATOR SIGNATURE:	DATE: 10/04/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2024

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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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 @ TEMPLETON ELEMENTARY	FACILITY NUMBER: 406215806
	VISIT DATE: 10/04/2024

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then every 5-years except after the date of the first test. For child care center licenses issued after 7/1/22, 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.

The CCC outdoor playground areas is on the grounds of the elementary school. The outdoor playground areas are enclosed by chain linked fencing. The fence’s entry/exit gates are secured. The surfaces of the outdoor playground areas are varied. LPAs observed age appropriate play equipment in the play areas. The play equipment is free of sharp, loose or pointed objects. The play structures in the outdoor playground areas have adequate cushioning materials to absorb falls. LPA also observed ample shade in the outdoor playground area created by trees. LPA notes the CCC shares the outdoor playground area with other children enrolled at the elementary school, however the CCC's play time is staggered from the elementary school. CCC children are monitored by CCC staff when in the playground area. The CCC also has outdoor activities in the front of the school's Multipurpose Room. LPA observed no bodies of water are observed on site.

A sampling of staff, children and facility records are reviewed by LPA. The children’s records were complete and found to contain emergency contact information and parent's rights receipts, among other required licensing documentation and forms. Staff records were complete and found to contain current Mandated Reporter training certifications and Pediatric First Aid/CPR (EMSA approved) certifications among other other required licensing documentation and forms. The CCC's fire drill log reveals the last fire drill was completed on 4/25/24. The CCC has a roster of children on site. Lead Teacher informed LPA no firearms or ammunition are 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, including (CONT. LIC 809-C, Page 3)

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Elvin Baddley
LICENSING EVALUATOR SIGNATURE:	DATE: 10/04/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2024

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 @ TEMPLETON ELEMENTARY	FACILITY NUMBER: 406215806
	VISIT DATE: 10/04/2024

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employees and volunteers, as specified in HSC section 1596.871, must obtain a criminal record clearance or exemption, or transfer their xisting 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.

Facility representative was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

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 Madison Sellers.

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Elvin Baddley
LICENSING EVALUATOR SIGNATURE:	DATE: 10/04/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2024

LIC809 (FAS) - (06/04)

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