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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434415371
Report Date: 04/18/2023
Date Signed: 04/20/2023 09:43:05 AM

Document Has Been Signed on 04/20/2023 09:43 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
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:KCE CHAMPIONS LLC @ LEDESMA ELEMENTARYFACILITY NUMBER:
434415371
ADMINISTRATOR:HELEN DE LA CRUZFACILITY TYPE:
840
ADDRESS:1001 SCHOOLHOUSE ROADTELEPHONE:
(408) 624-0533
CITY:SAN JOSESTATE: CAZIP CODE:
95138
CAPACITY: 55TOTAL ENROLLED CHILDREN: 55CENSUS: 30DATE:
04/18/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:20 PM
MET WITH:Ilse RichterTIME COMPLETED:
03:45 PM
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Licensing Program Analyst (LPA), Farida Raja, conducted a case management visit to obtain signatures on an annual inspection continuation (809-C) page that was created in error under a separate 809 created on the same day. LPA met with Site Director, Ilse Richter, and explained the nature of the visit. LPA obtained the required signature on the 809-C page. Present during the inspection were 30 children and 3 staff. Children were engage in outdoor play.

No deficiencies were cited as a result of today's inspection.

A NOTICE OF SITE VISIT WAS GIVEN AND MUST REMAIN POSTED FOR 30 CONSECUTIVE DAYS.
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Farida Raja
LICENSING EVALUATOR SIGNATURE: DATE: 04/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/18/2023
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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