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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 493010057
Report Date: 12/12/2024
Date Signed: 12/12/2024 01:09:17 PM

Document Has Been Signed on 12/12/2024 01:09 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 VISTAFACILITY NUMBER:
493010057
ADMINISTRATOR/
DIRECTOR:		JUNIOR, TIFFANYFACILITY TYPE:
840
ADDRESS:730 N WEBSTER STREETTELEPHONE:
(925) 457-7138
CITY:PETALUMASTATE: CAZIP CODE:
94952
CAPACITY: 120TOTAL ENROLLED CHILDREN: 38CENSUS: 0DATE:
12/12/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:42 PM
MET WITH:Taylor RamaliaTIME VISIT/
INSPECTION COMPLETED:
01:19 PM
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Licensing Program Analyst (LPA), Robert Maciel made an unannounced Plan of Correction (POC) visit and met with Director, Taylor Ramalia (S1), for the purpose of following up on an outstanding POC that was due by 01/19/2024. During the annual inspection on 12/20/2023, the facility was cited for staff 2 (S2) not possessing a current mandated reporter training certificate.

During today's visit, LPA observed no children in care. LPA requested facility records. Director stated that staff 2 (S2) no longer works at the facility. LPA gave Letter of Deficiency Citations Cleared to Director.

No deficiencies were cited during today's visit. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Director, Taylor Ramalia.
SUPERVISORS NAME: Erin Virrueta
LICENSING EVALUATOR NAME: Robert Maciel
LICENSING EVALUATOR SIGNATURE: DATE: 12/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/12/2024
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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