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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 406215807
Report Date: 08/17/2022
Date Signed: 08/17/2022 01:53:42 PM

Document Has Been Signed on 08/17/2022 01:53 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 @ VINEYARD ELEMENTARYFACILITY NUMBER:
406215807
ADMINISTRATOR:TAMARA PAYNE-ALEXFACILITY TYPE:
840
ADDRESS:2121 VINEYARD DRIVETELEPHONE:
(408) 348-1610
CITY:TEMPLETONSTATE: CAZIP CODE:
93465
CAPACITY: 31TOTAL ENROLLED CHILDREN: 31CENSUS: 0DATE:
08/17/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:20 AM
MET WITH:Dawn MartinTIME COMPLETED:
02:08 PM
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On August 17, 2022 at 11:25 AM, Licensing Program Analyst (LPA) Francisco Pedroza conducted an unannounced Annual/Random inspection. LPA met with facility Area Manager Dawn Martin and Director Kayleen Barger and advised them the purpose of the inspection. LPA was provided a tour of the facility inside and out. There was no children in care at the facility at the time of the inspection. Hours of operation are Monday - Friday 7:00 AM 8:15 AM and 1:40 PM - 6:00 PM

Facility is located on local school grounds. The facility is using three (3) classrooms for children in care. Primary care will conducted in the two (2) classroom. Facility has enough restrooms for children in care. The facility provides a snack to the children in care. LPA did not observe any hazards/toxins accessible to children in care. The school janitorial staff clean the facility. LPA observed age appropriate books, activities, and furniture readily accessible for children to use. Facility has one (1) large outdoor recreation yard with a play structure available for the children in care. Children have access to water inside and out.

Currently the facility is closed for the Summer break. No enrolled children files were accessible at the time of the inspection. Staff present is fully qualified. Facility is following current Covid-19 guidelines.

On July 27, 2022, the facility submitted an application for increase in capacity to Community Care Licensing (CCL). CCL submitted a fire clearance request to Templeton Fire Department (TFD) on July 27, 2022. On August 12, 2022 the facility was inspected by TFD and received an approved fire clearance for 75 children.

The center meets Title 22 Division 12 requirements.

Continued on 809-C
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Francisco Pedroza
LICENSING EVALUATOR SIGNATURE: DATE: 08/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/17/2022
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 @ VINEYARD ELEMENTARY
FACILITY NUMBER: 406215807
VISIT DATE: 08/17/2022
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No deficiencies were cited during today's inspection.

Effective today, August 17, 2022 facility is approved for a capacity of 75 School-age children.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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/process.

Director was reminded that all adults 18 and over, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the Area Manager and Director.
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Francisco Pedroza
LICENSING EVALUATOR SIGNATURE:

DATE: 08/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2022
LIC809 (FAS) - (06/04)
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