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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 444417045
Report Date: 08/10/2022
Date Signed: 08/10/2022 04:29:42 PM

Document Has Been Signed on 08/10/2022 04:29 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 @ BROOK KNOLL ELEMENTARYFACILITY NUMBER:
444417045
ADMINISTRATOR:ANJELICA DEL TOROFACILITY TYPE:
840
ADDRESS:151 BROOK KNOLL DRIVETELEPHONE:
(408) 624-0534
CITY:SANTA CRUZSTATE: CAZIP CODE:
95060
CAPACITY: 121TOTAL ENROLLED CHILDREN: 121CENSUS: 0DATE:
08/10/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
12:21 PM
MET WITH:Anjelica Del Toro and Brennan BernardoTIME COMPLETED:
02:30 PM
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Licensing Program Analyst (LPA) Samantha Yip conducted an announced pre-licensing inspection. LPA met with Anjelica Del Toro, Area Director, and Brennan Bernardo and explained the reason for the inspection. The purpose of this inspection is Applicant, KCE Champions LLC, is applying for a school-age license with a capacity of 121, serving ages 4.9 to 14 years old. Facility is located on the Brook Knoll Elementary campus in Room 12, Room 30, and the City of Scott’s Valley Parks and Recreation Portable Unit. A fire clearance for 121 was granted on 07/07/2022.

Since this School-Age Center will be operating on a functioning school site, the Center is exempt from requirement of square-footage for indoor and outdoor activity space, and toilet, fencing, and isolation space requirements for child day care centers, pursuant to Health and Safety Code Section 1596.806.

There is board to post required postings, such as notification of parent's rights, personal rights, car seat law, and emergency disaster plan. The hours of operation are Monday through Friday 6:30AM to 6PM. There is working phone.

LPA toured the inside and outside of the facility. Area Director stated that they will be mainly using the City of Scott's Valley Parks and Recreation Portable Unit. Cleaning supplies, disinfectant, and other items that are dangerous to children were inaccessible to children. LPA reminded staff that any disinfectant needs to inaccessible to children. There are toys for children. Children will be using baskets to store their belongings. Isolation area for children will be by the teacher's desk. There is a fully charged fire extinguisher and smoke

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SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE: DATE: 08/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/10/2022
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 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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 @ BROOK KNOLL ELEMENTARY
FACILITY NUMBER: 444417045
VISIT DATE: 08/10/2022
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detector. There is a carbon monoxide detector in Room 12. Facility representatives stated that there are no weapons, such as firearms, stored on the premise. There is a first aid kit.

Facility will be using the girls and boys restroom next to Room 13 for the children, which provides individual privacy and is separated. LPA discussed with Area Manager about supervising children when they are going to the restroom. There is a sink in each of the rooms.

Facility plans on using the lower playground and the upper playground. Area is fenced. Facility has a walkway that leads from the portables to the elementary school campus. Site Director stated that they will be getting rid of furniture and other items that are in the walkway. Areas around the play structure area and the swings have resilient materials to absorb falls. LPA observed that there are areas around the swings and monkey bars that are low. LPA also observed that one of the swing in the lower playground had rubber mulch, but the concrete is exposed. Brennan stated that he will inform the school and follow-up with Licensing. Brennan stated that it does not get fix that they will not allow children to use the swings in the lower playground. Shaded rest areas are provided through trees and building overhangs. There were no bodies of water observed during today's inspection.

Facility will only be providing snacks. There is fridge to store perishable snacks. Drinking water is provided through water pitchers. There is a menu that was posted. There is trash can with a tight-fitted trash can.

Facility will not be transporting children at this time.

This facility plans to provide Incidental Medical Services – IMS. For IMS information, see PIN 22-02-CCP. A Plan of Operation that includes IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of

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SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE:

DATE: 08/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/10/2022
LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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 @ BROOK KNOLL ELEMENTARY
FACILITY NUMBER: 444417045
VISIT DATE: 08/10/2022
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Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm
Facility does not plan on transporting children.

LPA reviewed with facility representative the LIC 311A, Records To Be Maintained At The Facility, for child’s records, personnel records, administrative records, and documents to be posted.

Facility representatives were reminded that all adults 18 and over responsible for administration or direct supervision of staff, persons who provides care and supervision to children, and staff who have contact with children, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform. To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

Facility will submit the following:
- proof that swings and any areas around the play structure has enough resilient materials
- rubber mulch below the swing in the lower playground is filled or fixed
- walkway is cleared

Exit interview conducted and report was reviewed with the facility representatives Anjelica Del Toro and Brennan Bernardo. LPA advised facility representatives upon approval of Licensing Management, a license for a school-age center will be granted and issued to Applicant.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE:

DATE: 08/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/10/2022
LIC809 (FAS) - (06/04)
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