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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334807508
Report Date: 09/17/2026
Date Signed: 09/17/2026 05:50:13 PM

Document Has Been Signed on 09/17/2026 05:50 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
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:KCE CHAMPIONS LLC @ TOMAS RIVERA ELEMENTARY SCHOOLFACILITY NUMBER:
334807508
ADMINISTRATOR/
DIRECTOR:		DESIREE PADILLAFACILITY TYPE:
840
ADDRESS:20440 RED POPPY LANETELEPHONE:
(951) 653-9477
CITY:RIVERSIDESTATE: CAZIP CODE:
92508
CAPACITY: 66TOTAL ENROLLED CHILDREN: 30CENSUS: 19DATE:
09/17/2026
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:15 PM
MET WITH:Emily Rubio, Lead TeacherTIME VISIT/
INSPECTION COMPLETED:
06:00 PM
NARRATIVE
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On the above date and time Licensing Program Analyst (LPA) Susan Brewer, conducted a case management inspection in response to the receipt of an unusual incident report (UIR) received from the facility on 09/08/2026. The It indicates that on 09/04/2026 the agency operated out of ratio. LPA was greeted by Lead Teacher Emily Rubio and granted entry to tour the facility inside and out. The LPA took a census of 19 children supervised by 2 staff. The director Trinitee Lucas was away from the facility. The director Melody Perez arrived and joined the inspection at 3:07 PM.

Observations were made, facility records were reviewed, and interviews were conducted by LPA S. Brewer. Records indicate that on 09/04/2026 at 2:40 PM the agency operated out of ratio with one subject staff supervising 15 children without an assistant. At 2:41 PM the ratio increased to 16 children supervised by 1 staff alone. The licensee self-reported the incident on 09/08/2026. Based on the information gathered, the following violations have been identified. Although the agency self-reported the incident, it was determined that on 09/04/2026 the agency remained out of ratio for a total of 46 minutes until 3:26 PM at which time ratio decreased to 14 children in care. The agency did not ensure a additional staff were scheduled to supervise and meet the needs of children enrolled and attending the child care program.

LPA Susan Brewer informed Director Melody Perez that this report dated 09/17/2026 documents a Type A citation for the California Code of Regulations, Title 22, Div. 12, 101516.5(b)(1) Teacher-Child Ratio which shall be posted for 30 consecutive days as there was an immediate risk to the health, safety, or personal rights of children in care.
See LIC809C Incident page 2
Samuel Lopez
Susan Brewer
DATE: 09/17/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/17/2026
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 4
California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: KCE CHAMPIONS LLC @ TOMAS RIVERA ELEMENTARY SCHOOL
FACILITY NUMBER: 334807508
VISIT DATE: 09/17/2026
NARRATIVE
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Also, LPA Susan Brewer informed Director Melody Perez to provide a copy of this licensing report dated 09/17/2026 that documents any Type A citation 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.

No civil penalties were issued on today’s date.

An exit interview was conducted, and this report was reviewed and provided to Director Melody Perez.

A Notice of Site Visit was issued and must remain posted for 30 days. The LPA observed the licensee post the Notice of Site Visit prior to exiting the facility.
NAME OF LICENSING PROGRAM MANAGER: Samuel Lopez
NAME OF LICENSING PROGRAM ANALYST: Susan Brewer
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/17/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2026
LIC809 (FAS) - (06/04)
Page: 3 of 4
Document Has Been Signed on 09/17/2026 05:50 PM - It Cannot Be Edited


Created By: Susan Brewer On 09/17/2026 at 04:28 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: KCE CHAMPIONS LLC @ TOMAS RIVERA ELEMENTARY SCHOOL
FACILITY NUMBER: 334807508

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/17/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/18/2026
Section Cited
CCR
101516.5(b)(1)

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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. (1) A teacher shall supervise no more than 14 children...
This requirement is not met as evidenced by:
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The agency agrees to ensure a staffing ratio of one teacher and one aide present to every 28 children in attendance, and a teacher will supervise no more than 14 children without a an assistant.
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Based on interviews, record reviews and the licensee's self-reported admission, it was determined that on 09/08/2026 the agency operated with 1 staff supervising 16 children without an assistant, which is an immediate risk to the health & safety of persons in care.
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The licensee also agrees to submit a written plan of action to ensure the regulations is met, with staff schedule to meet the ratios of children enrolled and attending the daycare. The plan can be submitted by fax, mail or email.

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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.
Samuel Lopez
NAME OF LICENSING PROGRAM MANAGER:
Susan Brewer
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 09/17/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/17/2026


LIC809 (FAS) - (06/04)
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