<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343622956
Report Date: 06/27/2023
Date Signed: 06/27/2023 10:25:38 AM

Document Has Been Signed on 06/27/2023 10:25 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:KCE CHAMPIONS LLC @ EDNA BATEYFACILITY NUMBER:
343622956
ADMINISTRATOR:KIM BRASSYFACILITY TYPE:
850
ADDRESS:9421 STONEBROOK DRIVETELEPHONE:
(916) 479-4977
CITY:ELK GROVESTATE: CAZIP CODE:
95624
CAPACITY: 16TOTAL ENROLLED CHILDREN: 5CENSUS: 5DATE:
06/27/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Kim BrassyTIME COMPLETED:
10:30 AM
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
Application Specialist (AS) Alecia Sifuentes and Licensing Program Analyst (LPA) Jennie Tedlos met with Site Director Kim Brassy for the purpose of a case management inspection. Licensee requests a room change and change of capacity to serve 21 preschool children age two years to entry into kindergarten. The preschool program is located at Edna Batey Elementary School. The program currently operates Monday through Friday from 7:00 a.m. to 5:30 p.m.

INDOOR ACTIVITY SPACE:
There is one preschool classroom located in portable 1 (room #3). AS observed a sufficient amount of equipment, toys, tables, chairs, nap mats, cubbies. AS measured room #3. The total classroom space contains a total of 843 square feet, which will accommodate Licensee’s request for 21 preschool children. There are two toilets and one sink for the children. AS observed a shared bathroom waiver on file. There is separate private restroom for the staff. Individual measurements are recorded on the Capacity Worksheet (LIC 9024).

OUTDOOR ACTIVITY SPACE:
There is one outdoor area on the property. The outdoor play area is fenced with a wrought iron fence that is at least four feet tall. Site Director utilizes cones to separate the preschool yard from the elementary school yard. Site Director has requested a shared outdoor space waiver. There is no play structure. Site Director has requested to expand the preschool yard. AS measured the outdoor activity space. The outdoor play area contains a total of 13,990 square feet, which will accommodate Licensee's request for 21 preschool children. Individual measurements are recorded on the Capacity Worksheet (LIC 9024).

Report continues on LIC809-C.
SUPERVISORS NAME: Jeanne Smith
LICENSING EVALUATOR NAME: Alecia Sifuentes
LICENSING EVALUATOR SIGNATURE: DATE: 06/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/27/2023
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 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: KCE CHAMPIONS LLC @ EDNA BATEY
FACILITY NUMBER: 343622956
VISIT DATE: 06/27/2023
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
26
27
28
29
30
31
32
Licensee was reminded that all adults 18 and over, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with the Site Director, Kim Brassy.

The following item is required before AS will approve the room change and change of capacity:
1. Updated granted fire clearance (STD850)
SUPERVISORS NAME: Jeanne Smith
LICENSING EVALUATOR NAME: Alecia Sifuentes
LICENSING EVALUATOR SIGNATURE:

DATE: 06/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/27/2023
LIC809 (FAS) - (06/04)
Page: 2 of 2