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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434415371
Report Date: 09/10/2024
Date Signed: 09/10/2024 04:21:55 PM

Document Has Been Signed on 09/10/2024 04:21 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
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:KCE CHAMPIONS LLC @ LEDESMA ELEMENTARYFACILITY NUMBER:
434415371
ADMINISTRATOR/
DIRECTOR:		ILSE RICHTERFACILITY TYPE:
840
ADDRESS:1001 SCHOOLHOUSE ROADTELEPHONE:
(408) 807-7157
CITY:SAN JOSESTATE: CAZIP CODE:
95138
CAPACITY: 55TOTAL ENROLLED CHILDREN: 55CENSUS: 50DATE:
09/10/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:21 AM
MET WITH:Ilse RichterTIME VISIT/
INSPECTION COMPLETED:
03:30 PM
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On 09/10/2024 at 11:21 am, Licensing Program Analyst (LPA), Farida Raja conducted an unannounced annual/random inspection in the school age program and met with Director, Ilse Richter. LPA explained the purpose of today’s inspection. The facility provides before and after school care to children from kindergarten through 6th grade in two portable rooms located on the Ledesma Elementary School campus. LPA observed the required posted materials including menus. Days and hours of operation are Monday through Friday, 6:30 AM-8:15 AM before school and 1:30 pm - 5:30 pm after school. The two portable classrooms are used for the Preschool Program from 8:45 AM- 12 PM and the same two classrooms are used for the School Age Program for before and after school care.

LPA toured the indoor and outdoor areas of the school age program during today's inspection. LPA observed 50 children and 5 teachers. Facility is in compliance with teacher to children ratio requirements.

Classrooms, children's restrooms and kitchen/storage area were inspected. There is a working telephone at the facility. Disinfectants, cleaning solutions or chemicals that are dangerous to the health and safety of children were stored under sink in a closed room and are inaccessible to children. Furniture and equipment were age appropriate and in good condition, free of sharp, loose, or pointed parts. Restrooms for children were observed to be in safe, sanitary, and operating condition. Floors were clean and free from tripping hazards. Drinking water is readily available for children in each room and in the outdoor playground area via individual water bottles and refilled using bathroom sinks. Director states that there are no weapons or firearms on the premises.

LPA observed 2 fire extinguishers and fire pull stations. The facility has built in smoke detector/ fire system. Log shows that the last Fire Drill was conducted on 08/30/2024 which is compliant with the six-month requirement for facilities.

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SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Farida Raja
LICENSING EVALUATOR SIGNATURE: DATE: 09/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/10/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: KCE CHAMPIONS LLC @ LEDESMA ELEMENTARY
FACILITY NUMBER: 434415371
VISIT DATE: 09/10/2024
NARRATIVE
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Foods and beverages were stored safely in the kitchen area. Food storage and preparation areas were observed to be sanitary. All food and beverages that require refrigeration were stored in covered containers. The facility offers afternoon snack for the school age children. All snacks were observed to be kept in labelled containers. Medications were observed to be stored in the kitchen area in high cabinets and inaccessible to children.

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. Water lead testing was completed by the facility on December 10, 2022. LPA provided Director with the Water Lead Report from the California State Water Resources Control Board during today's inspection. LPA observed that the indoor drinking water fountain (F) with the Action Level Exceedance is not being used to provide water to children. LPA observed water fountain is covered and signage placed stating do no use. LPA advised Director to remove water fountain fixture or stop supply of water to the fountain.

School age children use the elementary school playground located in front of Buildings 500 and 600. Outdoor playground and play equipment was inspected and observed to be free of hazards. LPA observed play equipment was in good condition, age-appropriate, and has sufficient resilient materials to absorb falls. Shade is provided by solar panels and building overhang. There were no bodies of water observed.



Children sign in and out procedures and logs were reviewed. Children's Roster was reviewed and a copy was provided to LPA. A sampling of 8 children's files and 2 staff files were reviewed. Each child's file reviewed contained the required forms. Upon review of medications, LPA observed child, C6 has an Epinephrine Autoinjector that expired in October 2022 and has not been returned or renewed by facility.

Staff, S2 is missing current Mandated Reporter Training. LPA observed that staff, S1 is cleared but not associated with this facility. Staff file reviewed contain the required transcripts/verification of experience.

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SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Farida Raja
LICENSING EVALUATOR SIGNATURE:

DATE: 09/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2024
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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
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: KCE CHAMPIONS LLC @ LEDESMA ELEMENTARY
FACILITY NUMBER: 434415371
VISIT DATE: 09/10/2024
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At least one staff member on site has a current CPR and First Aid certification on file. Director understands that there shall be at least one person, with valid CPR and First Aid certifications, on site at all times or present during off-site activities (field trips). Staff have the required Immunization's against pertussis, measles and influenza or a statement declining the vaccine.

Director was reminded that all adults 18 and over, 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.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. Director will submit an Incidental Medical Plan to the Department by 09/24/2024. Isolation of sick child was discussed, and Director explained that sick children will be is either isolated near the front desk to wait for parents and isolation equipment will be provided. A restroom which is off limits to other children is used if necessary. Child is always under visual supervision while in care of the facility. 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/.

LPA reminded Director that facility annual fees are overdue and a letter was sent to the mailing address on 08/30/2024 reminding them of overdue fees. LPA provided Director with a copy of the notice for the preschool and school age license during today's inspection.

Facility does not provide transportation to children, but Director understands that children cannot be left alone, unattended in parked vehicles. Director 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.

Three (3) Type B deficiencies were cited as a result of today's inspection. Appeal rights provided. Exit interview conducted and report was reviewed with the Site Director, Ilse Richter.



A NOTICE OF SITE VISIT WAS GIVEN AND MUST REMAIN POSTED FOR 30 CONSECUTIVE DAYS

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

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Farida Raja
LICENSING EVALUATOR SIGNATURE:

DATE: 09/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2024
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Document Has Been Signed on 09/10/2024 04:21 PM - It Cannot Be Edited


Created By: Farida Raja On 09/10/2024 at 02:24 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: KCE CHAMPIONS LLC @ LEDESMA ELEMENTARY
FACILITY NUMBER: 434415371

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/10/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101170(e)(2)
101170 Criminal Record Clearance (e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility: (2) Request a transfer of a criminal record clearance as specified in Section 101170(f).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview and record review, the licensee did not comply with the section cited above for one staff which poses a potential health, safety or personal rights risk to persons in care. LPA observed that Staff, S1 is cleared and associated with the company but not associated with this facility location.
POC Due Date: 09/24/2024
Plan of Correction
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Director to submit a written plan of correction to LPA by plan of correction due date of 09/24/2024.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Gladys Kuizon
LICENSING EVALUATOR NAME:Farida Raja
LICENSING EVALUATOR SIGNATURE:
DATE: 09/10/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/10/2024


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Document Has Been Signed on 09/10/2024 04:21 PM - It Cannot Be Edited


Created By: Farida Raja On 09/10/2024 at 02:42 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: KCE CHAMPIONS LLC @ LEDESMA ELEMENTARY
FACILITY NUMBER: 434415371

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/10/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview and record review the licensee did not comply with the section cited abovefor one staff, S2 which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/24/2024
Plan of Correction
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Director to have staff, S2 complete training and submit proof to LPA by POC due date of 09/24/2024
Type B
Section Cited
CCR
101226(e)(3)(A)
Health-Related Services
(3) Prescription medications may be administered if all of the following conditions are met: (A) Prescription medications shall be administered in accordance with the label directions as prescribed by the child's physician.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview and record review, the licensee did not comply with the section cited above for one child, C6 which poses a potential health, safety or personal rights risk to persons in care. LPA observed child, C6 has an Epinephrine Autoinjector that expired in October 2022 and has not been returned or renewed by facility.
POC Due Date: 09/24/2024
Plan of Correction
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Director shall submit a written plan of how the center will check expiration dates on medications and request renewal or return expired medication to authorized representatives. Director will return C6s medication and obtain new medication for the child in care. Director will send proof of correction to LPA by 09/24/2024.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Gladys Kuizon
LICENSING EVALUATOR NAME:Farida Raja
LICENSING EVALUATOR SIGNATURE:
DATE: 09/10/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/10/2024


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