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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 444417045
Report Date: 04/18/2023
Date Signed: 04/18/2023 12:09:20 PM

Document Has Been Signed on 04/18/2023 12:09 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: 90CENSUS: 0DATE:
04/18/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
11:23 AM
MET WITH:Sarah HinkleTIME COMPLETED:
12:18 PM
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Licensing Program Analysts (LPAs), Cortney Nelson and Jovani Dillon, met with Site Director, Sarah Hinkle, and explained purpose of today's visit, to follow-up on deficiencies cited on 4/11/2023.

The following deficiencies were due on 4/14/2023: letter regarding completion of sign-in/out and proof of completion of Mandated Reporter Training (Child Care Providers AB1207) for staff members.

The following deficiency was due on 4/12/2023: submission of staff qualifications (proof of job experience).

Civil penalties have been assessed at a rate of $100 per day since original due date for plan of correction. Civil penalties will end once corrections have been submitted to the Department.

LPAs provided a copy of staff needs for each deficiency.

Exit interview conducted and report was reviewed with Site Director, Sarah Hinkle.

A NOTICE OF SITE VISIT HAS BEEN ISSUED AND MUST BE POSTED FOR 30 DAYS.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Cortney Nelson
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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