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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 406215807
Report Date: 02/22/2024
Date Signed: 02/22/2024 09:24:36 AM

Document Has Been Signed on 02/22/2024 09:24 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
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME:KCE CHAMPIONS LLC @ VINEYARD ELEMENTARYFACILITY NUMBER:
406215807
ADMINISTRATOR:DAWN MARTINFACILITY TYPE:
840
ADDRESS:2121 VINEYARD DRIVETELEPHONE:
(408) 348-1610
CITY:TEMPLETONSTATE: CAZIP CODE:
93465
CAPACITY: 75TOTAL ENROLLED CHILDREN: 75CENSUS: 0DATE:
02/22/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
07:21 AM
MET WITH:Marques Lopez/ Dawn MartinTIME COMPLETED:
09:30 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
On February 22, 2024, Licensing Program Analyst (LPA) Francisca Velazquez conducted an unannounced Case Management Inspection. Licensee submitted documentation to add an additional room that will be used for child care service. LPA notes there is no change in capacity. LPA met with Marques Lopez, primary teacher discussed the purpose of the inspection. At the time of the inspection there were zero (0) children present, as no children arrived for services today.

The facility is located on the grounds of Vineyard Elementary School. The school-age program operates Monday – Friday 7:00AM – 8:15AM and Monday, Tuesday, Thursday, Friday from 2:30 PM - 6:00 PM and Wednesday from 1:30 PM - 6:00 PM. Currently the facility uses one (1) classroom for child care services (classroom D-1) and is requesting to add an additional classroom to provide child care services (classroom D-2).

LPA observed classroom to contain age-appropriate toys and equipment and is in safe and sanitary conditions. LPA observed children will have access to eleven (11) toilets, two (2) urinals and four (4) sinks. Two (2) separate hand washing sinks are also available in the classrooms (one in each classroom). Outdoor play area consists of grassing, one blacktop yard with soft foam, and play structure. Perimeter fencing and gates are present throughout the entire school.

Total indoor area available for care and supervision in classroom D1 is 868/35= 24 children, classroom D2 is 856.76/35= 24 children, and the multipurpose room is 69 ft X 84 ft= 7596/35= 165 children.

On 2/1/24, the Templeton Fire Department granted a fire clearance following a fire inspection of the facility.

A notice of site visit was given to licensee and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days.

Exit interview conducted and report was reviewed with facility representative, Marques Lopez and Licensee, Dawn Martin (present over phone).

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Francisca Velazquez
LICENSING EVALUATOR SIGNATURE: DATE: 02/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/22/2024
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 1