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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434416681
Report Date: 11/02/2021
Date Signed: 11/02/2021 01:59:43 PM

Document Has Been Signed on 11/02/2021 01:59 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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:KCE CHAMPIONS LLC @ MURDOCK-PORTAL ELEMENTARYFACILITY NUMBER:
434416681
ADMINISTRATOR:JACQUELINE NAVARROFACILITY TYPE:
840
ADDRESS:1188 WUNDERLICH DRIVETELEPHONE:
(408) 665-9337
CITY:SAN JOSESTATE: CAZIP CODE:
95129
CAPACITY: 121TOTAL ENROLLED CHILDREN: 121CENSUS: 22DATE:
11/02/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Marcos EstradaTIME COMPLETED:
02:06 PM
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LPA Pete Hernandez conducted an announced Case Management - Other inspection of the Facility today. Direcor Marcos Estrada and explained the reason for the inspection. The program will be using the following rooms: School-age: Rooms 25 and 26. The purpose, was to complete a capacity increase request to 70 children in care on a functioning school site identified as class rooms numbers 25 and 26: Murdock-Portal Elementary School. A Fire Clearance was granted on 10/20/2021 by the San Jose Fire Department in conjunction with the School Principal providing a letter dated 10/11/2021 authorizing use for up to 70 children. Outdoor space is more than adequate for the number of children in care for the purposes of this inspection report. LPA toured and inspected the indoor and outdoors of the Facility during today's inspection. There are two bathrooms inside the facility; one for the adults and one for the children. There are also school ground restrooms a short walk away on the school grounds.

An exit interview was conducted with Director Marcos Estrada. Consistent with the updated fire clearance rooms 26 and 26 will be updated with the license. Upon approval by Licensing Management, a capacity change and license for a school-age child care center will be granted and issued to the Licensee.

A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE ENTRANCE TO THE FACILITY, AND MUST REMAIN POSTED FOR 30 DAYS.
SUPERVISORS NAME: Sandy Knight
LICENSING EVALUATOR NAME: Pietro Hernandez
LICENSING EVALUATOR SIGNATURE: DATE: 11/02/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/02/2021
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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