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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 444417046
Report Date: 10/06/2022
Date Signed: 10/06/2022 11:07:28 AM

Document Has Been Signed on 10/06/2022 11:07 AM - 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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:KCE CHAMPIONS LLC @ VINE HILL ELEMENTARYFACILITY NUMBER:
444417046
ADMINISTRATOR:ANJELICA DEL TOROFACILITY TYPE:
840
ADDRESS:151 VINE HILL SCHOOL ROADTELEPHONE:
(408) 624-0534
CITY:SCOTTS VALLEYSTATE: CAZIP CODE:
95066
CAPACITY: 120TOTAL ENROLLED CHILDREN: 70CENSUS: 0DATE:
10/06/2022
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Anjelica Del Toro & Sandra ValdezTIME COMPLETED:
11:18 AM
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Licensing Program Analyst (LPA), Cortney Nelson, met with Area Manager, Anjelica Del Toro, and Site Director, Sandra Valdez, for inspection of newly constructed portable for before and after school care. The facility is located at Vine Hill Elementary School in the "Rec Room" portable (designated as Champions Before and After School Care on campus map). During todays inspection, LPA met with Anjelica in front of the school office and toured inside and outside of the "Rec Room" portable. LPA observed all required postings near the entrance of the facility and there is a working telephone.

The facility anticipates starting care for children on Monday, October 10, 2022. The hours of operation will be 6:30am-8:30am and 2:35pm/2:45pm-6:00pm. On Wednesdays the school has early release and children will attend starting at 12:35pm/12:45pm. 1st-3rd grade is released 10 minutes prior to 4th-5th grade. The capacity for the "Rec Room" portable is 62 children. All children (TK-5th) will be combined from approximately 4:30pm-6:00pm in the "Rec Room" potable.

There are a total of six (6) staff members who will be working in the "Rec Room" portable and Anjelica states that she is still in the process of on-boarding new staff. The "Rec Room" portable will be for the care of 1st-5th grade students and portable 6 will be used for the care of Transitional Kindergarten and Kindergarten students. Anjelica states that the children attending the "Rec Room" portable will walk to the building once school is released.

Anjelica 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.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Cortney Nelson
LICENSING EVALUATOR SIGNATURE: DATE: 10/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/06/2022
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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: KCE CHAMPIONS LLC @ VINE HILL ELEMENTARY
FACILITY NUMBER: 444417046
VISIT DATE: 10/06/2022
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LPA observed two (2) 3A40BC fire extinguishers (last serviced 10/2022), functioning carbon monoxide detectors and the building has internal fire/smoke detectors as it is on a school campus. Anjelica states that most materials are already in the portable, however there are a few smaller items that will be moved after school on Friday (10/7). Indoor areas of the facility were inspected by the LPA today and observed to be clean, orderly, and safe for the day care children. LPA observed sufficient age-appropriate materials, toys, and play equipment in the facility. Water will be provided to the children via two (2) drinking fountains located outside. LPA observed that water fountains were not functioning today and advised they are repaired prior to children starting care.

Staff and children’s bathrooms are clean, sanitary, and operable. There is one (1) toilet in the girls restroom that is not flushing and needs repair and one (1) sink that needs a faucet cap to control the water release. The bathrooms for children are located in a separate building next to the "Rec Room" portable and Anjelica states that staff will walk children to the restroom as needed. The children's bathrooms will only be used by Champions and the staff bathrooms located outside may be utilized by staff on campus. There is a separate staff bathroom located inside of the "Rec Room" portable, not utilized by the children, which an isolated child can use if necessary.

Afternoon snack is provided to the children in the after school program through US Foods. Anjelica states that the snack will be brought to the "Rec Room" portable from portable 6 before the children arrive and all snacks are currently individually wrapped per child. The "Rec Room" portable has a mini fridge that can be utilized for any snacks that may need to be refrigerated. LPA observed menu is in writing and posted at least one week in advance, accessible to authorized representatives.

Outdoor areas of the facility were inspected today and observed to be fenced in. There are two temporary fences located near the facility and LPA observed that they are securely attached to the permanent fence. Anjelica states that she is not sure when they will be repaired. LPA observed school playground is age-appropriate with sufficient resilient materials (tanbark) to absorb falls. There are a large number of benches/tables with overhang for shade that children can use. No outdoor bodies of water were observed during today’s inspection.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Cortney Nelson
LICENSING EVALUATOR SIGNATURE:

DATE: 10/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2022
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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: KCE CHAMPIONS LLC @ VINE HILL ELEMENTARY
FACILITY NUMBER: 444417046
VISIT DATE: 10/06/2022
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Anjelica understands that the Site Director, Sandra, shall be on the premises during the hours the center is in operation and that children at the center shall be visually supervised at all times. LPA reminded Anjelica 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, such as field trips. The facility anticipates enrolling children who may need medication or IMS and LPA reviewed proper storage with Anjelica and Sandra. There are no weapons or firearms on the premises.

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 Evaluator Manual- Regulation Interpretations and Procedures for Child Care Centers, Section 101173 and 101226. The following information regarding ADA was provided: US Department of Justice 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

Exit interview conducted and report was reviewed with Area Manager, Anjelica Del Toro and Site Director, Sandra Valdez.

As a result of today’s inspection, no deficiencies were cited the "Rec Room" portable is not currently part of provisional license. (Currently licensed portables: P4, P5, P6, & P7.)

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

LPA advised that building will be approved to be added to the provisional license upon the following physical plant repairs and final manager approval:

-In the girls restrooms, one (1) toilet and one (1) sink need repair
-Two (2) drinking fountains located outside for children's drinking water need repair
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Cortney Nelson
LICENSING EVALUATOR SIGNATURE:

DATE: 10/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2022
LIC809 (FAS) - (06/04)
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