Community Care Licensing

Document Has Been Signed on 04/18/2023 03:39 PM - It Cannot Be Edited

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

Link to Parent Document Below:

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 B 04/21/2023 Section Cited CCR 101170.1(b)	1 2 3 4 5 6 7	101170.1 Criminal Record Exemptions (b)...the licensee must return the confirmation of removal form that is sent by the Department, within five (5) days of the date of the form, that confirms under penalty of perjury that the individual has been removed from the facility.	1 2 3 4 5 6 7	The Licensee will submit confirmation of removal to the Department by 4/21/2023.
	8 9 10 11 12 13 14	This requirement was not met as evidenced by: The Site Director did not submit confirmation of removal within five (5) days, which poses a potential risk to the health, safety, and personal rights of children in care.	8 9 10 11 12 13 14
Type B 04/21/2023 Section Cited CCR101229.1(b)	1 2 3 4 5 6 7	101229.1 Sign In and Sign Out (b) The person who brings the child to, and removes the child from, the center shall sign the child in/out. This requirement was not met as evidenced by:	1 2 3 4 5 6 7	The Licensee will submit a letter indicating how the facility will ensure children will be signed in upon arrival by 4/21/2023.
	8 9 10 11 12 13 14	The Site Director did not ensure that children attending the facility were signed in upon arrival which poses a potential risk to the health, safety, and personal rights of children in care.	8 9 10 11 12 13 14

SUPERVISOR'S 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

Link to Parent Document Below:

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 B 04/21/2023 Section Cited CCR 101216(g)(1)	1 2 3 4 5 6 7	101216 Personnel Requirements (g) All personnel... shall be in good health and shall be physically and mentally capable of performing assigned tasks. (1)... good physical health shall be verified by a health screening, including a test for tuberculosis, performed by... a physician not more than one year prior to or seven days after employment or licensure.	1 2 3 4 5 6 7	The Licensee will submit physicians report, or confirmation of scheduled appointment, and proof of negative tuberculosis (TB) test, to the Department by 4/21/2023.
	8 9 10 11 12 13 14	This requirement was not met as evidenced by: Four out of seven personnel files reviewed did not have proof physicians report, which poses a potential risk to the health, safety, and personal rights of children in care.	8 9 10 11 12 13 14
Type B 04/21/2023 Section Cited HSC1596.7995(a)(1)	1 2 3 4 5 6 7	1596.7995(a)(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year. This requirement was not met as evidenced by:	1 2 3 4 5 6 7	The Licensee will submit proof of required immunizations for two staff member to the Department by 4/21/2023.
	8 9 10 11 12 13 14	The Site Director did not provide proof of required immunizations for two out of seven personnel files reviewed, which poses a potential risk to the health, safety, and personal rights of children in care.	8 9 10 11 12 13 14

SUPERVISOR'S 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

Link to Parent Document Below:

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 B 04/21/2023 Section Cited HSC 1596.841	1 2 3 4 5 6 7	1596.841 Each child day care facility shall maintain a current roster of children who are provided care in the facility. The roster shall include the name, address, and daytime telephone number of the child's parent or guardian, and the name and telephone number of the child's physician. This roster shall be available to the licensing agency upon request.	1 2 3 4 5 6 7	The Licensee will submit a fully completed children's roster (LIC9040) to the Department by 4/21/2023.
	8 9 10 11 12 13 14	This requirement was not met as evidenced by: The facility did not have a children's roster, which poses a potential 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

SUPERVISOR'S 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