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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004844
Report Date: 12/05/2023
Date Signed: 12/05/2023 05:39:03 PM

Document Has Been Signed on 12/05/2023 05:39 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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:KCE CHAMPIONS LLC @ SACRED HEART SCHOOLSFACILITY NUMBER:
414004844
ADMINISTRATOR:SALAH, AMANYFACILITY TYPE:
850
ADDRESS:50 EMILIE AVENUETELEPHONE:
(650) 223-1804
CITY:ATHERTONSTATE: CAZIP CODE:
94027
CAPACITY: 60TOTAL ENROLLED CHILDREN: 20CENSUS: 10DATE:
12/05/2023
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
02:05 PM
MET WITH:Director, Jessica JimenezTIME COMPLETED:
03:45 PM
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On December 5th, 2023 at approximately 2:05pm, Licensing Program Analyst (LPA) Tapia-Mandujano arrived at the facility to conduct an unannounced, annual inspection. LPA met with Director, Jessica Jimenez and explained the purpose of the inspection. Present in the facility are Director and two staff caring and supervising a total of 10 preschool age children. All adults working in the facility are fingerprint cleared and associated to the facility. Facility is currently operating within teacher to child ratio on this date.

During today's inspection, LPA conducted a health and safety inspection of room 4. Due to insufficient time, the CARE tool inspection was not completed.

During today's inspection, LPA observed classrooms to be clean and equipped with age appropriate toys and materials. Storage for children's belongings are located inside the classrooms, labeled with each child's individual names. LPA observed facility has an installation of a fire alarm system inside each classroom as well as a fully charged, fire extinguisher inside of the classroom. The classrooms have a smoke and carbon monoxide detector installed as well as emergency kits with first aid materials and emergency contact information.. Per Director, there are children with prescribed medication. Depending on the medication, it is kept within the classroom or in the school nurses office. Facility has a plan in place to properly store Medication, inaccessible to enrolled children and will be maintained with proper documentation in each classroom.

All poisons, cleaning solutions and hazardous materials are stored inaccessible to children in off limit areas or facility high shelves. Facility offers snack only. Menus are posted by the parent table and by snack preparation area. Water is available to children indoors and outdoors.

A continuation inspection will have to be conducted at another date due to insufficient time available.

No deficiencies were cited at this moment.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with Director, Jessica Jimenez.
SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Leslit Tapia-Mandujano
LICENSING EVALUATOR SIGNATURE: DATE: 11/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/08/2023
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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