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

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 444417046
Report Date: 04/18/2023
Date Signed: 04/18/2023 03:41:41 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/25/2023 and conducted by Evaluator Cortney Nelson
PUBLIC
COMPLAINT CONTROL NUMBER: 07-CC-20230125150829
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:120CENSUS: 66DATE:
04/18/2023
UNANNOUNCEDTIME BEGAN:
01:25 PM
MET WITH:Stephanie StellmanTIME COMPLETED:
03:51 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility is operating out of ratio.

Uncleared adults provided care and supervision to daycare children.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analysts (LPAs), Cortney Nelson and Jovani Dillon, met with Site Director, Stephanie Stellman, and explained purpose of visit- to interview staff and deliver complaint investigation findings. LPAs were admitted into the facility by the Site Director upon arrival.

LPAs reviewed pertinent documents, such as personnel files and staff payroll, observed the facility, and interviewed staff/site director. Five out of five staff members interviewed reported being over ratio. A staff member with an exemption denial continued to be employed despite order of removal issued 10/13/2022. Based on the available documentation, the preponderance of evidence standard has been met, therefore the above allegations are SUBSTANTIATED.

California Code of Regulations (Title 22, Division 12) are being cited on attached LIC9099-D.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Cortney Nelson
LICENSING EVALUATOR SIGNATURE:

DATE: 04/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/18/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 4
Control Number 07-CC-20230125150829
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: 04/18/2023
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
26
27
28
29
30
31
32
LPAs informed Site Director, Stephanie Stellman, that this report dated 4/18/2023 documents two Type A citations, which shall be posted for 30 consecutive days as there is an immediate risk to the health, safety, or personal rights of children in care.

Also, LPAs informed the Site Director to provide a copy of this licensing report dated (4/18/2023) that documents two Type A citations to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

Civil penalties regarding criminal record clearances have been assessed, updated rate of $150 per day excluded individuals are present in the facility, per Health & Safety Code 1596.99(c)(6), have been applied.

$150 per day x 26 days (as reflected on payroll) = $3900 civil penalty, invoice will be issued separately, and is not reflected on LIC421BG.

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

A NOTICE OF SITE VISIT WAS GIVEN AND MUST BE 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: 04/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/18/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 07-CC-20230125150829
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/18/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/19/2023
Section Cited
CCR
101516.5(b)
1
2
3
4
5
6
7
101516.5 Teacher-Child Ratio (b) There shall be a staffing ratio of one teacher and one aide present to every 28 children in attendance.

This requirement was not met as evidenced by:
1
2
3
4
5
6
7
The Licensee will submit a letter summarizing the steps that have been taken to ensure staff:child ratio requirements will be met at the facility. Letter to be submitted to the Department by 4/19/2023.
8
9
10
11
12
13
14
The Site Director did not ensure that staff:child ratio requirements were met, as staff reported supervising more than 14 children, which poses an immediate risk to the health, safety, and personal rights of children in care.
8
9
10
11
12
13
14
Request Denied
Type A
04/19/2023
Section Cited
CCR
101170.1(q)(2)
1
2
3
4
5
6
7
101170.1 Criminal Record Exemptions (q) If a request for an exemption has been denied, the individual shall be excluded for a period of two years... (2) An exclusion order based solely upon a denied exemption shall remain in effect and the individual shall not be employed in or present in a licensed facility... unless either a petition or an exemption is granted.
1
2
3
4
5
6
7
Written attestment to be submitted from the Licensee that the excluded individual will not be present in the facility. Letter to be submitted to the Department by 4/19/2023.
8
9
10
11
12
13
14
This requirement was not met as evidenced by:

The Site Director continued to employ staff member after removal date of 10/13/2022, which poses an immediate risk to the health, safety, and personal rights of children in care.
8
9
10
11
12
13
14
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Cortney Nelson
LICENSING EVALUATOR SIGNATURE:

DATE: 04/18/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/18/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 07-CC-20230125150829
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/18/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/19/2023
Section Cited
CCR
101170(d)
1
2
3
4
5
6
7
101170 Criminal Record Clearance (d) All individuals subject to criminal record review shall, be fingerprinted and sign a Criminal Record Statement (LIC 508 [Rev. 1/03]) under penalty of perjury.

This requirement was not met as evidenced by:
1
2
3
4
5
6
7
The Licensee shall get staff member fingerprinted or transfer fingerprints to the license. Staff member shall not be present in the facility until fingerprint clearances have been obtained.
8
9
10
11
12
13
14
The Site Director did not obtain fingerprint clearances for one staff member, which poses an immediate risk to the health, safety, and personal rights of children in care.
8
9
10
11
12
13
14
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Cortney Nelson
LICENSING EVALUATOR SIGNATURE:

DATE: 04/18/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/18/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 4