<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 444417045
Report Date: 08/07/2023
Date Signed: 08/07/2023 02:15:30 PM

Document Has Been Signed on 08/07/2023 02:15 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:SARAH HINKLEFACILITY TYPE:
840
ADDRESS:151 BROOK KNOLL DRIVETELEPHONE:
(408) 624-0534
CITY:SANTA CRUZSTATE: CAZIP CODE:
95060
CAPACITY: 121TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
08/07/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
01:24 PM
MET WITH:Anjelica Del Toro & Sarah HinkleTIME COMPLETED:
02:30 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA), Cortney Nelson, met with Facility Representative, Anjelica Del Toro, and Site Director, Sarah Hinkle, in response to classroom change for the upcoming school year. During today's inspection, Brook Knoll Elementary School was hosting an open house meet & greet for parents/children attending the school. There are no children currently in care at the facility and the school year will be starting on Thursday, August 10th.

The facility is currently licensed to use the following rooms: 12, 30, and City of Scotts Valley Parks and Rec. Portable Unit. The portable unit is currently undergoing construction to replace the outer siding and renovate the walls of the unit. Construction expected to be completed by the end of August 2023.

Anjelica states that the facility is planning to utilize classroom 10 while construction is on-going for the portable unit. Classroom 10 will be used for "homework club" for children grades 1st and up. Room 30 will be used for children aged TK-K and Room 12 will be used for grades 1st and up. Classroom 10 is equipped with a built in fire system, functioning carbon monoxide detector, and a 3A40BC fire extinguisher. During the school day, the classroom is utilized for english language and intervention for K-5th. There are 5 tables and 23 chairs available for use.

LPA requested that Anjelica submit letter from superintendent for use of classroom 10 and the indicated capacity for the room. LPA additionally requested the facility submit updated facility sketch for indoor of room 10 and full campus sketch indicating rooms used by Champions.

LPA advised that proof of completed construction work shall be submitted to the Department prior to resuming use of the portable. Another visit shall be conducted to tour the portable upon completion of construction and revise license to include portable unit.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Cortney Nelson
LICENSING EVALUATOR SIGNATURE: DATE: 08/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/07/2023
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 2
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: 08/07/2023
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
During today's inspection, LPA advised Anjelica to replace provisional license with current license on the required postings board. LPA additionally advised posting updated passenger safety law poster (PUB269 (2/18)), completing emergency disaster plan (LIC610), and complete Notification of Parents Right with San Jose Regional office contact information. LPA advised Anjelica and Sarah to submit photo of required postings with updated information prior to the first day of school (8/10).

LPA advised that the following documents must be submitted prior to classroom change approval:
-Letter from Superintendent for room use and capacity requirements
-Updated Facility Sketches (LIC999) for classroom 10 and school campus
-Updated required postings for classrooms used by Champions

Once construction has been completed, follow-up will be conducted to start using portable again. License will be issued to add classroom 10 following manager review and approval.

Exit interview conducted and report was reviewed with Facility Representative, Anjelica Del Toro, and Site Director, Sarah Hinkle.

As a result of today's inspection, no deficiencies were cited.

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

DATE: 08/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2023
LIC809 (FAS) - (06/04)
Page: 2 of 2