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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334819673
Report Date: 12/05/2023
Date Signed: 12/05/2023 03:55:34 PM


Document Has Been Signed on 12/05/2023 03:55 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
INLAND EMPIRE CHILD, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501



FACILITY NAME:KCE CHAMPIONS LLC @ MARK TWAIN ELEMENTARY SCHOOLFACILITY NUMBER:
334819673
ADMINISTRATOR:DEBORAH HILLFACILITY TYPE:
840
ADDRESS:19411 KRAMERIA AVETELEPHONE:
(951) 640-5943
CITY:RIVERSIDESTATE: CAZIP CODE:
92508
CAPACITY:45CENSUS: 23DATE:
12/05/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:19 PM
MET WITH:Site Director Kimberly BanksTIME COMPLETED:
04:00 PM
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On the above date and time, Licensing Program Analyst (LPA) Susan Brewer, arrived at the facility for the purpose of conducting a Case Management Inspection, related to a separate matter. LPA was greeted by the Site Director Kimberly Banks and granted entry to tour the facility. LPA took a census of 23 children supervised by the Site director and 2 additional staff members.

During the inspection the LPA gathered records and conducted interviews with pertinent parties. No violations are determined.

A notice of site visit was issued and must remain posted for public view for 30 days.

An exit interview was conducted and a copy of this report was provided to Site Director Kimberly Banks.
SUPERVISOR'S NAME: Kimberly WilliamsTELEPHONE: (951) 782-4200
LICENSING EVALUATOR NAME: Susan BrewerTELEPHONE: (951) 782-4200
LICENSING EVALUATOR SIGNATURE:
DATE: 12/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/05/2023
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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