<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 444417046
Report Date: 02/01/2023
Date Signed: 02/01/2023 02:35:09 PM

Document Has Been Signed on 02/01/2023 02:35 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, 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: 134CENSUS: 69DATE:
02/01/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:56 PM
MET WITH:Stephanie StellmanTIME COMPLETED:
02:45 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analysts (LPAs) Cortney Nelson and Jovani Dillon, met with Site Director, Stephanie Stellman, and explained purpose of today's visit.

LPA's reviewed staff files and observed that required documents are missing, such as physicians reports, proof of immunization record, tuberculosis test, Mandated Reporter training, and transcripts/proof of education. LPA's additionally noted that a new Site Director has started at the facility and the Area Manager, Angelica Del Toro, failed to notify Licensing within ten (10) days of the new director starting and submit qualifications for review.

As a result of today's inspection, deficiencies have been cited, see 809-D.

Exit interview conducted and report was reviewed with the Site Director, Stephanie Stellman.

A NOTICE OF SITE VISIT WAS GIVEN AND MUST REMAIN POSTED FOR 30 DAYS. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Cortney Nelson
LICENSING EVALUATOR SIGNATURE: DATE: 02/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/01/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
Document Has Been Signed on 02/01/2023 02:35 PM - It Cannot Be Edited


Created By: Cortney Nelson On 02/01/2023 at 02:01 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 @ VINE HILL ELEMENTARY
FACILITY NUMBER: 444417046

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/01/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/03/2023
Section Cited
CCR
101212(b)

1
2
3
4
5
6
7
101212 Reporting Requirements (b) The name of the child care center director... shall be reported to the Department within 10 days of a change of child care center director or designee.

This requirement was not met as evidenced by:
1
2
3
4
5
6
7
Area Manager, Angelica Del Toro, will submit Site Director qualifications for Stephanie Stellman for review. All required documents should be submitted for review by 2/3/2023.
8
9
10
11
12
13
14
Site Director present at the facilty, Stephanie Stellman, was associated to the facility on 1/8/2023, and the department was not notified of changes which poses a potential threat to the health, safety, and personal rights of children in care.
8
9
10
11
12
13
14
Additionally, qualifications should include letter of experience from previous employers and proof of 3 semester units of administrative course.
Type B
02/03/2023
Section Cited
CCR101217(a)

1
2
3
4
5
6
7
101217 Personnel Records (a) The licensee shall ensure that personnel records are maintained on the licensee, administrator, and each employee. Each personnel record shall contain the following information:

This requirement was not met as evidenced by:
1
2
3
4
5
6
7
Area Manager, Angelica Del Toro, will submit proof of education/transcripts, Mandated Reporter training, immunizations (MMR, Tdap, flu), and required experience for review to determine qualifications of staff.
8
9
10
11
12
13
14
The licensee failed to maintain personnel records as many required documents were missing which poses a potential threat to the health, safety, and personal rights of children in care.
8
9
10
11
12
13
14
Staff are additionally missing proof of physicians report and negative TB test, which should also be submitted. All documents should be submitted by 2/3/2023 for all staff present during 2022-2023 school year.
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:Joel Segura
LICENSING EVALUATOR NAME:Cortney Nelson
LICENSING EVALUATOR SIGNATURE:
DATE: 02/01/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/01/2023


LIC809 (FAS) - (06/04)
Page: 2 of 2