Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334841007
Report Date: 05/03/2016
Date Signed 05/03/2016 04:10:10 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:CHAMPIONS AT WOODCREST ELEMENTARYFACILITY NUMBER:
334841007
ADMINISTRATOR:AMANDA CARLSONFACILITY TYPE:
840
ADDRESS:16940 KRAMERIA AVENUETELEPHONE:
(951) 780-1215
CITY:RIVERSIDESTATE: CAZIP CODE:
92504
CAPACITY:35CENSUS: 16DATE:
05/03/2016
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
02:20 PM
MET WITH:Karen GreerTIME COMPLETED:
04:15 PM
NARRATIVE
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3 A Random Annual visit is being conducted as a compliance review. Licensing Program Analyst (LPA) Judith Simms toured the center, inside and out. The following was observed: When LPA initially arrived at the center, LPA was told by office staff the program doesn't open until 2:40 PM. The licensing information on the LIC 200A reads the program operates Monday thru Friday in the afternoon from 12:20 PM till 6:00 PM. However, that is incorrect. The licensee changed their Plan of Operation. Not only did they change their hours of operation, they also changed the center director. The licensee failed to submit to ccl the new director packet for licensing to approve. The licensee will need to submit the following to LPA by 5/9/2016, updated LIC 200A, LIC 500, LIC 610, LIC 308, a complete director packet, a new parent handbook which should include the new hours of operation and admission policies and procedures and an updated schedule.
· The facility is operating within the terms of the license no, the hours of operation changes. See LIC809D
· Ratios were met during this visit
· Appropriate supervision was provided during the visit
· Classrooms are equipped with age appropriate furniture and equipment in good condition
· Classrooms are clean and free of hazards
· Fire extinguishers, smoke detectors, and carbon monoxide detectors meet State Fire Marshall standards
· There are no weapons stored at the facility
SUPERVISOR'S NAME: Lya JohnsonTELEPHONE: (951) 782-4216
LICENSING EVALUATOR NAME: Judith SimmsTELEPHONE: (951) 204-4847
LICENSING EVALUATOR SIGNATURE:

DATE: 05/03/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2016
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 5


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: CHAMPIONS AT WOODCREST ELEMENTARY
FACILITY NUMBER: 334841007
VISIT DATE: 05/03/2016
NARRATIVE
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· Staff member’s CPR/First Aid expires on 10/17
· A review of staff records contain appropriate documentation of education credits: No see LIC809D
· Medications are stored where inaccessible to children
· The facility operates as follows: The AM session operates from 6:30 AM to 9:00 AM, Monday thru Friday. The afternoon session operates as follows: Monday Tuesday and Thurs 1:50 PM to 6:00pm. Wednesday from 12:45 PM to 6:00 PM. Friday the center operates from 1:00 PM to 6:00 PM
· This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. The licensee has submitted a Plan for Providing IMS.
· Hazards are stored where inaccessible to children
· Storage areas for toxins are locked
· All floors are clean and safe
· Bathrooms were observed to be safe, sanitary and in operating condition
· Playground equipment is in good condition, free from sharp loose or pointed parts
· Uncontaminated drinking water is available both inside and out
· Area under/around high play equipment, swings, and slides have sufficient cushioning material
· Outdoor activity space surface is maintained in a safe condition and free from hazards
· Food preparation, storage areas are clean and free of litter, rubbish and vermin/rodents
· Food is stored appropriately and protected from contamination, and contaminated food is discarded immediately
· Solid waste storage vessels, including moveable bins, have tight-fitting covers on, are in good repair
· All foods/beverages capable of rapid spoiling are stored in covered containers at 45 (F) or less
· Menus are posted at least one week in advance, where an authorized representative can view them, are dated and kept on file for 30 days, and are available upon request
SUPERVISOR'S NAME: Lya JohnsonTELEPHONE: (951) 782-4216
LICENSING EVALUATOR NAME: Judith SimmsTELEPHONE: (951) 204-4847
LICENSING EVALUATOR SIGNATURE:

DATE: 05/03/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2016
LIC809 (FAS) - (06/04)
Page: 2 of 5


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: CHAMPIONS AT WOODCREST ELEMENTARY
FACILITY NUMBER: 334841007
VISIT DATE: 05/03/2016
NARRATIVE
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· Sign in/Sign out record was reviewed and meets regulation requirements, full legal signature
· Child’s admission agreement is available for review
· Child is signed in and out by the person responsible for the child
· A review of staff records on 05/03/16 indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

See LIC 809D for deficiencies cited.

·The facility representative was advised that the Notice of Site Visit must be posted at the entrance of the facility for a period of 30 days. If a serious violation is cited, a copy of the licensing report (LIC809) must also be posted for 30 days. If these requirements are not met, civil penalties in the amount of $100 per violation will be assessed.
· AB 978 – Zero Tolerance Related Regulations went into effect January 18, 2011 – In accordance with California Health and Safety Code Section 1596.99(c)/1597.58(c) – it was explained that an immediate $150 Civil penalty will be assessed for each serious violation and a civil penalty of $150 per day per violation will be assessed until corrected.
· AB 2084 – Nutritious Beverages in Child Care Facilities went into effect January 1, 2012- In accordance with California Health and Safety Code Section 1596.808- licensee was issued a copy of this new law during this visit.
· AB 2109 amended Health and Safety Code Section 120365, relating to communicable disease to require an additional form prescribed by the State Department of Public Health (CDPH). This form shall be signed by an authorized health care practitioner and parent or guardian when exempting a child from required immunization(s) due to personal beliefs.

Exit interview conducted appeal rights discussed and a copy of this report was left at the facility.
SUPERVISOR'S NAME: Lya JohnsonTELEPHONE: (951) 782-4216
LICENSING EVALUATOR NAME: Judith SimmsTELEPHONE: (951) 204-4847
LICENSING EVALUATOR SIGNATURE:

DATE: 05/03/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2016
LIC809 (FAS) - (06/04)
Page: 3 of 5


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: CHAMPIONS AT WOODCREST ELEMENTARY
FACILITY NUMBER: 334841007
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/03/2016
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/09/2016
Section Cited
101216(g)(1)(2)
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Personnel Requirements. All personnel including the licensee shall have a health-screening report, including specified information, signed by the person who performed it.

There is no physical or TB clearance in file for Karen Greer.
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The licensee agrees to submit to a copy of the health screening report including the TB clearance to ccl by the due date.
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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: Lya JohnsonTELEPHONE: (951) 782-4216
LICENSING EVALUATOR NAME: Judith SimmsTELEPHONE: (951) 204-4847
LICENSING EVALUATOR SIGNATURE:

DATE: 05/03/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2016
LIC809 (FAS) - (06/04)
Page: 5 of 5


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: CHAMPIONS AT WOODCREST ELEMENTARY
FACILITY NUMBER: 334841007
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/03/2016
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/09/2016
Section Cited
101218 (a)
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Admission Policies - The hours of operation have changed. The program no longer opens at 12:20 PM. The facility is not operating in accordance to what is stated on the license.
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The licensee agrees to submit to ccl, an updated admission policy that states the actual hours the program operates and submit and updated schedule and parent handbook.
Type B
05/09/2016
Section Cited
101173 (a) (b)
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Plan of Operation - The licensee is not operating in accordance with the license. The licensee change their hours of operation which affect program operation and how the facility is licensed.
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The licensee agrees to submit to ccl an updated LIC 200A to ccl by 5/9/16
Type B
05/09/2016
Section Cited
101212(b)
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Reporting Requirements. The name of the child care center director or fully qualified teacher(s) designated to act in the director’s absence shall be reported to the Department with in 10 days of a change.
The licensee hired a new center director and failed to notify ccl with in the 10 day time period.
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The licensee agrees to submit to a complete center director packet including component lll orientation to ccl by the due date of 5/9/16.
Type B
05/09/2016
Section Cited
101215.1(h)(1)
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101215.1(h)(1)(A)(B) Child Care Center Directors Qualifications and Duties - The center director, Karen Greer was lacking proof of educational requirements as being qualified as center director as there were no transcripts in file.
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The licensee agrees to submit to ccl transcripts for Karen Greer no later than the due date.
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: Lya JohnsonTELEPHONE: (951) 782-4216
LICENSING EVALUATOR NAME: Judith SimmsTELEPHONE: (951) 204-4847
LICENSING EVALUATOR SIGNATURE:

DATE: 05/03/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2016
LIC809 (FAS) - (06/04)
Page: 4 of 5