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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 313623670
Report Date: 07/26/2021
Date Signed: 07/26/2021 12:50:09 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME:KCE CHAMPIONS LLC @ STONE RIDGEFACILITY NUMBER:
313623670
ADMINISTRATOR:HOLLOWAY, AMARAFACILITY TYPE:
840
ADDRESS:2501 ALEXANDRA DRTELEPHONE:
(916) 757-3244
CITY:ROSEVILLESTATE: CAZIP CODE:
95661
CAPACITY:60CENSUS: DATE:
07/26/2021
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Amy DodgeTIME COMPLETED:
01:00 PM
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On July 26th, 2021, at 12:00 pm Licensing Program Analyst (LPA) Jeremey McClain met with Licensee Representative Amy Dodge for the purpose of a case management inspection. No children were present during today’s inspection. The licensee has requested a capacity change to decrease from 60 to 30 children, and has also requested a room change and utilize room 32 instead of rooms 6 and 10 .

A health and safety inspection was conducted of the new room that will be used for care.
INDOOR SPACE
LPA observed age appropriate furnishings and equipment. Per Health and Safety Code 1596.806, the facility is exempt from square footage requirement; therefore, measurements were not taken. The children will use the school’s restrooms, and a separate private restroom for the staff. Children who become ill during the day will be isolated in the cozy corner and will use the staff restroom, if necessary.

OUTDOOR SPACE
No changes have been made to the outdoor space.

A Fire Clearance was granted on July 15th,, 2021.

As of today, Licensee's request for capacity decrease and room change is approved.

LPA did not observe any deficiencies during today’s inspection. This report was reviewed with the Director. A
Notice of Site Visit was provided and must remain posted for 30 days.
SUPERVISOR'S NAME: Keven PetersTELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Jeremey McClainTELEPHONE: (916) 216-7801
LICENSING EVALUATOR SIGNATURE:

DATE: 07/26/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2021
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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