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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376701382
Report Date: 09/22/2022
Date Signed: 09/22/2022 03:30:54 PM


Document Has Been Signed on 09/22/2022 03:30 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, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108



FACILITY NAME:KCE CHAMPIONS LLC AT KAVODFACILITY NUMBER:
376701382
ADMINISTRATOR:ALEXIA MORALESFACILITY TYPE:
840
ADDRESS:6991 BALBOA AVENUETELEPHONE:
(858) 221-3744
CITY:SAN DIEGOSTATE: CAZIP CODE:
92111
CAPACITY:140CENSUS: 0DATE:
09/22/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Director, Alexia Morales TIME COMPLETED:
10:35 AM
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Licensing Program Analyst (LPA) Jennifer Lott conducted a Case Management visit to deliver an amended report. LPA was greeted at the front of the facility by Director, Alexia Morales and was granted entry after identifying herself and disclosing the purpose of her visit. The purpose of LPA's visit was to deliver an amended report for a visit conducted on 09/14/2022.

During today's visit, LPA obtained, Director, Alexia Morales’ signature on the amended report LIC 809/809D dated 09/14/2022.

An exit interview was conducted and a copy of this report was provided. A notice of site visit was given and must remain posted for 30 days.

SUPERVISOR'S NAME: Tashima DanielTELEPHONE: (619) 629-8413
LICENSING EVALUATOR NAME: Jennifer LottTELEPHONE: 619-782-8300
LICENSING EVALUATOR SIGNATURE:
DATE: 09/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/22/2022
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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