493010057-3-6-2024-01-CC-JSNW-D357D8-20240306203353

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 493010057
Report Date: 03/06/2024
Date Signed: 03/06/2024 08:35:27 PM

Document Has Been Signed on 03/06/2024 08:35 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
SANTA ROSA CC RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME:	KCE CHAMPIONS LLC @ VALLEY VISTA		FACILITY NUMBER:	493010057
ADMINISTRATOR:	JUNIOR, TIFFANY		FACILITY TYPE:	840
ADDRESS:	730 N WEBSTER STREET		TELEPHONE:	(925) 457-7138
CITY:	PETALUMA	STATE: CA	ZIP CODE:	94952
CAPACITY: 60	TOTAL ENROLLED CHILDREN: 60	CENSUS: 46	DATE:	03/06/2024
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Jessica Joerger		TIME COMPLETED:	04:45 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	An increase of capacity prelicensing inspection was conducted March, 6 2024 at 1:pm by Licensing Program Analyst (LPA), Snow to increase the capacity. LPA Snow met with facility representative Jessica Joerger/director of KCE Champions LLC @ Valley Vista to conduct an inspection of the Valley Vista school age program before and after school program. The program is located in room #3, #17,the mobile/child care building and the multi purpose room. The facility has requested an increase from 60 to 120 school aged children, age 4-12 years. Fire clearance was approved on 1/31/24. Hours and days of operation M-F 7am-830am & MT,TH,F 1:50pm -6pm & Wed 11:50am-6pm. They are open through school holidays & summer 8am-5pm. The facility is on the Valley Vista Elementary school grounds. This program meets Health and Safety Code 1596.806(a)(1 & 2), (b), (b)(1) and (d) and is therefore exempt from the toilet, interior and exterior activity square footage and outdoor fencing requirement. There is a toilet/sink for the children and another for the staff the childcare mobile room. The facility provides snacks only. Food prep area is in room #3. The indoor and outdoor activity spaces were toured, and the facility sketch was verified. No areas will be off limits to children. They use the elementary school play yards. The isolation area for sick children will be located in the office. There is safe and age-appropriate furniture, toys, and play equipment available for children. There is no pool, spa, pond, fountain, or any other body of water on the premises The poisons are locked in the janitor’s closet. Director, Jessica said there are no weapons on property.

SUPERVISORS NAME: Mai Lor
LICENSING EVALUATOR NAME: Jaime Snow
LICENSING EVALUATOR SIGNATURE:	DATE: 03/06/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2024

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
SANTA ROSA CC RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: KCE CHAMPIONS LLC @ VALLEY VISTA	FACILITY NUMBER: 493010057
	VISIT DATE: 03/06/2024

NARRATIVE

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Facility, Director, Jessica was reminded that all adults 18 and over responsible for administration or direct supervision of staff, persons who provides care and supervision to children, and staff who have contact with children, 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.

This facility previously submitted a plan to provide Incidental Medical Services – IMS. For IMS information, see PIN 22-02-CCP. A Plan of Operation that includes IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) tollfree 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, available at: http://www.ada.gov/childqanda.htm. LPA reviewed with facility Director, Jessica the LIC 311A, Records to Be Maintained At The Facility, for child’s records, personnel records, administrative records, and documents to be posted.
LPA discussed the safe sleep regulations with Carrie Escobedo facility representative and discussed the Child Care Licensing Safe Sleep webpage at: https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep, as an additional resource.

LPA also informed facility director, Jessica of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at: https://www.cpsc.gov/, and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

SUPERVISORS NAME: Mai Lor
LICENSING EVALUATOR NAME: Jaime Snow
LICENSING EVALUATOR SIGNATURE:	DATE: 03/06/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2024

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
SANTA ROSA CC RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: KCE CHAMPIONS LLC @ VALLEY VISTA	FACILITY NUMBER: 493010057
	VISIT DATE: 03/06/2024

NARRATIVE

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Representative, Jessica was informed of the MyChildCarePlan.org site, 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.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platforms. To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-carelicensing/subscribe and select the Child Care option to receive email communication.

• LIC309 (Administrative Organization) – updated
• LIC610 (Emergency and Disaster Plan) – updated with 2 temporary locations & letters of permission if applicable
• LIC500 (Personnel Report) – updated with additional staff for 120 kids
• Facility Sketch, updated birdseye sketch that shows where the licensed classrooms, yards, parking, other buildings are in relation to each other
• Admission Agreement -updated
• Parent Handbook -updated
• Job descriptions – is updated
Change of director documents submitted in 2023 (cab LPA will follow up with case LPA)
Additional documents & managerial approval will be required after a full file review.

SUPERVISORS NAME: Mai Lor
LICENSING EVALUATOR NAME: Jaime Snow
LICENSING EVALUATOR SIGNATURE:	DATE: 03/06/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2024

LIC809 (FAS) - (06/04)

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