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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 393622564
Report Date: 11/04/2021
Date Signed: 11/04/2021 12:13:29 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 @ TRACY LEARNING CTRFACILITY NUMBER:
393622564
ADMINISTRATOR:BECK, BRITTANYFACILITY TYPE:
840
ADDRESS:51 E. BEVERLY PLACETELEPHONE:
(209) 207-4461
CITY:TRACYSTATE: CAZIP CODE:
95376
CAPACITY:42CENSUS: 0DATE:
11/04/2021
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Melissa JostedtTIME COMPLETED:
01:00 PM
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Application Specialist (AS) Alecia Sifuentes met with Area Manager, Melissa Jostedt for the purpose of an announced case management inspection. Licensee requests a change of capacity and a second classroom addition. The facility's hours of operation are Monday through Friday from 6:00 a.m. to 7:45 a.m. and 3:30 p.m. to 6:00 p.m. AS observed the charter school's fire clearance for 1/21/2021 is on file.

A health and safety inspection was conducted in all areas accessible to children. Licensee is requesting a capacity increase of 84 school-age children. Superintendent/Principal letter is on file allowing the program to utilize classrooms P2 and P6. Per Health and Safety Code 1596.806, the facility is exempt from square footage requirement; therefore, AS did not take measurements. The children will use the school’s restrooms, and a separate private restroom for the staff. AS observed a functional smoke and carbon monoxide detectors in the classroom. AS observed disinfectants are inaccessible and appropriately stored.

This facility provides Incidental Medical Services – IMS. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm.

This facility evaluation report was reviewed and discussed with Licensee. Licensee was encouraged to the visit the Department's website at WWW.CDSS.CA.GOV for information regarding child care updates, forms, regulations and legislation pertaining to child care centers.

Effective today, 11/4/2021, AS will approve the facility’s classroom addition and capacity change for 84 school-age children.
SUPERVISOR'S NAME: Jeanne SmithTELEPHONE: (916) 208-4405
LICENSING EVALUATOR NAME: Alecia SifuentesTELEPHONE: (916) 917-9202
LICENSING EVALUATOR SIGNATURE:

DATE: 11/04/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2021
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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