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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 406215806
Report Date: 09/30/2022
Date Signed: 09/30/2022 01:50:33 PM

Document Has Been Signed on 09/30/2022 01:50 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
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME:KCE CHAMPIONS LLC @ TEMPLETON ELEMENTARYFACILITY NUMBER:
406215806
ADMINISTRATOR:DAWN MARTINFACILITY TYPE:
840
ADDRESS:215 EIGHTH STREETTELEPHONE:
(408) 348-1610
CITY:TEMPLETONSTATE: CAZIP CODE:
93465
CAPACITY: 75TOTAL ENROLLED CHILDREN: 75CENSUS: 1DATE:
09/30/2022
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
12:34 PM
MET WITH:Lily RuelasTIME COMPLETED:
02:05 PM
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On September 30, 2022 at 12:40 PM, Licensing Program Analyst (LPA) Frank Pedroza conducted an unannounced Case Management inspection. LPA met with site Director Lily Ruelas and advised her the purpose of the inspection. Director provided LPA a tour of the facility. There was one (1) child in care and one (1) teacher supervising at the time of the inspection.

On August 30, 2022, Community Care Licensing (CCL) received a request from the facility have a fire clearance inspection to add two (2) additional classrooms for children in care. Currently the facility provides care for children in the multipurpose room and facility library. Templeton fire department came on September 12, 2022 to conduct a fire clearance inspection. CCL received the approved fire clearance on September 29, 2022 approving the two (2) additional classrooms. During today's inspection, LPA inspected and measured the two additional rooms. The facility will be using classrooms L-3 and L-4 for primary care of children care. The multipurpose room and library will be used for when the facility has an overflow of children in care.

The center meets Title 22 Division 12 requirements.

Effective today, September 30, 2022, facility maintains their current capacity of 75 children and are authorized to use the two (2) new classrooms for care.
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Francisco Pedroza
LICENSING EVALUATOR SIGNATURE: DATE: 09/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/30/2022
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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