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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 444417045
Report Date: 10/19/2023
Date Signed: 10/19/2023 12:24:19 PM

Document Has Been Signed on 10/19/2023 12:24 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: 121CENSUS: 26DATE:
10/19/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
11:51 AM
MET WITH:Sarah HinkleTIME COMPLETED:
12:33 PM
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Licensing Program Analyst (LPA), Cortney Nelson, met with Site Director, Sarah Hinkle, to follow-up on construction completed for the portable used by the facility. LPA was admitted into the facility by the Site Director upon arrival.

During case management visit conducted on 8/7/2023, the facility indicated that the City of Scotts Valley Parks and Rec Portable Unit was undergoing construction to replace the outer siding and renovate the walls of the unit. LPA advised Area Manager, Anjelica Del Toro, to submit proof of completion for renovation of the portable.

LPA observed that construction/renovation for the portable has been completed. The portable is equipped with materials for the children, including tables, chairs, activity zones, and cubbies. The facility is now cleared to resume operation in the portable. Sarah states that the following rooms will continued to be used by KCE Champions at Brook Knoll: 10, 12, 30, and Scotts Valley Parks and Rec Portable Unit. The license generated on 8/10/2023 reflects the current rooms used by the facility and no further changes are required at this time.

Sarah states that the portable still needs final treatment for the wood, which will be completed when there is no one present at Brook Knoll Elementary. She states that it is planned to be completed during Thanksgiving break and that she was advised the portable is already cleared to begin being used prior to the treatment being completed.

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

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

A NOTICE OF SITE VISIT WAS GIVEN AND MUST BE POSTED FOR 30 DAYS.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Cortney Nelson
LICENSING EVALUATOR SIGNATURE: DATE: 10/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/19/2023
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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