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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 406206847
Report Date: 08/01/2022
Date Signed: 08/01/2022 01:16:52 PM

Document Has Been Signed on 08/01/2022 01:16 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, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME:KCE CHAMPIONS LLC @ SAN BENITOFACILITY NUMBER:
406206847
ADMINISTRATOR:TAMARA PAYNE-ALEXFACILITY TYPE:
840
ADDRESS:4300 SAN BENITOTELEPHONE:
(805) 975-6105
CITY:ATASCADEROSTATE: CAZIP CODE:
93422
CAPACITY: 24TOTAL ENROLLED CHILDREN: 24CENSUS: 0DATE:
08/01/2022
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME BEGAN:
12:56 PM
MET WITH:Bridget MilesTIME COMPLETED:
01:30 PM
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On August 1, 2022 at 1:00 PM, Licensing Program Analyst (LPA) Francisco Pedroza conducted an announced Case Management inspection. LPA met with facility site supervisor Bridget Miles and advised her the purpose of the inspection. Site supervisor provided LPA a tour of the facility inside and out. There was no children in care at the time of the inspection. The facility is closed for the Summer and anticipate resuming operations on August 17, 2022.

On July 8, 2022 the licensee submitted an application to increase their capacity from 24 children to 58. Community Care Licensing (CCL) requested a fire clearance from Atascadero Fire Department on July 8, 2022. On July 13, 2022 the facility received an approved fire clearance for 58 children. The facility will be using two (2) classrooms adjacent to one another. They plan to use one classroom for the younger children and the other for the older children. The facility has access to the school restrooms for the children. They will be using the school blacktop for outdoor recreation.

The center meets Title 22 Division 12 requirements.

Effective today, August 1, 2022 facility is approved for a capacity of 58 School-age children.
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Francisco Pedroza
LICENSING EVALUATOR SIGNATURE: DATE: 08/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/01/2022
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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