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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 444417045
Report Date: 08/26/2024
Date Signed: 08/26/2024 11:53:30 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/28/2024 and conducted by Evaluator Melvin S Matos
PUBLIC
COMPLAINT CONTROL NUMBER: 07-CC-20240528132906
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:121CENSUS: 0DATE:
08/26/2024
UNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Jordan ArmstrongTIME COMPLETED:
11:10 AM
ALLEGATION(S):
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Facility operating out of ratio
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Mel Matos met with Jordan Armstrong, Director, for an unannounced follow up complaint investigation. Purpose of today's investigation: Deliver investigation findings. Today's investigation was conducted in the Rec Portable Unit of the Facility. LPA toured the room, reviewed staff files, and interviewed Jordan Armstrong, Director, and one staff during today's investigation.

Based on interviews, record reviews, observations, and evidence gathered during the investigation process, the Department concludes the Facility was operating out of ratio when one partially qualified teacher opened the Facility on the following dates: 05/14/24, 05/16/24, 05/21/24, 05/23/24 and was the only staff present with anywhere from one to six children present during the dates listed above. The allegation noted above is thus found to be SUBSTANTIATED, meaning the allegation is valid because the preponderance of the evidence standard has been met. One "Type B" deficiency is being cited on the attached LIC 9099-D. Exit interview conducted and report was reviewed with the Director, Jordan Armstrong. Appeal rights was also provided to Jordan prior to conclusion of today's inspection.
Notice of site visit was issued and must remain posted for 30 days
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Belinda Devall
LICENSING EVALUATOR NAME: Melvin S Matos
LICENSING EVALUATOR SIGNATURE:

DATE: 08/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
Control Number 07-CC-20240528132906
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: KCE CHAMPIONS LLC @ BROOK KNOLL ELEMENTARY
FACILITY NUMBER: 444417045
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/26/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/03/2024
Section Cited
CCR
101516.5(b)(1)
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Teacher-Child Ratio: A teacher shall supervise no more than 14 children or with an aide a maximum of 28 children. This requirement was not met as evidenced by: the Facility was operating out of ratio when one partially qualified teacher opened the Facility on the
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Jordan Armstrong, Director, agreed to submit a written Plan of Correction (POC) by Tuesday September 3, 2024. The Plan of Correction shall include the Facility protocol for ensuring that a director or fully qualified teacher shall be present to open or close the Facility at all times.
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following dates: 05/14/24, 05/16/24, 05/21/24, 05/23/24 and was the only staff present with anywhere from one to six children present during the early morning session. This presents a potential risk to the health, safety, or personal rights of children in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Belinda Devall
LICENSING EVALUATOR NAME: Melvin S Matos
LICENSING EVALUATOR SIGNATURE:

DATE: 08/26/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/28/2024 and conducted by Evaluator Melvin S Matos
PUBLIC
COMPLAINT CONTROL NUMBER: 07-CC-20240528132906

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:121CENSUS: 0DATE:
08/26/2024
UNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Jordan ArmstrongTIME COMPLETED:
11:10 AM
ALLEGATION(S):
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9
Facility staff does not provided adequate supervision to daycare children in care
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Mel Matos met with Jordan Armstrong, Director, for an unannounced follow up complaint investigation. Purpose of today's investigation: Deliver investigation findings. Today's investigation was conducted in the Rec Portable Unit of the Facility. LPA toured the room, reviewed staff files, and interviewed Jordan Armstrong, Director, and one staff during today's investigation.

Based on interviews, observations, record reviews, and evidence gathered during the investigation process, it is concluded that although the allegation noted on this complaint may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation did or did not occur. The allegation is thus UNSUBSTANTIATED.

Exit interview conducted and report was reviewed with the Director, Jordan Armstrong. No deficiencies issued. A notice of site visit was given and must remain posted for 30 days.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Belinda Devall
LICENSING EVALUATOR NAME: Melvin S Matos
LICENSING EVALUATOR SIGNATURE:

DATE: 08/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 3