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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376701549
Report Date: 06/22/2023
Date Signed: 06/26/2023 08:43:05 PM

Document Has Been Signed on 06/26/2023 08:43 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
CCLD Regional Office, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME:KCE CHAMPIONS LLC @ CROWNFACILITY NUMBER:
376701549
ADMINISTRATOR:DANIELLE CAVANAUGHFACILITY TYPE:
850
ADDRESS:199 6TH STREETTELEPHONE:
(619) 375-7203
CITY:CORONADOSTATE: CAZIP CODE:
92118
CAPACITY: 24TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
06/22/2023
TYPE OF VISIT:OfficeANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Danielle CavanaughTIME COMPLETED:
01:14 PM
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On 6/22/23 at 12:30pm, Licensing Program Analyst (LPA), Martha Malane met with Area Manager, Danielle Cavanaugh for an office meeting at the San Diego Regional Office. The purpose of today's meeting was to review pending documents listed on the LIC184C - Notice of Incomplete Application.

LPA reviewed and discussed the pending documents in detail with Area Manager, Danielle Cavanaugh.

An exit interview was conducted with Area Manager, Danielle Cavanaugh.
SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: Martha Malane
LICENSING EVALUATOR SIGNATURE: DATE: 06/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/22/2023
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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