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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 393622564
Report Date: 03/11/2022
Date Signed: 03/11/2022 11:46:24 AM


Document Has Been Signed on 03/11/2022 11:46 AM - 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, 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:84CENSUS: 0DATE:
03/11/2022
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Melissa JostedtTIME COMPLETED:
12:30 PM
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Application Specialist (AS) Alecia Sifuentes met with Area Manager, Melissa Jostedt and Site Director, Brittany Beck for the purpose of an announced case management inspection. Licensee requests to add the school gym in addition to the already existing classrooms. 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 not making any changes to the capacity. Superintendent/Principal letters are on file allowing the program to utilize classrooms P2, P6, and the school gym. 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.

Licensee was reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

A notice of site visit was given and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with the Area Manager, Melissa Jostedt.

Effective today, 3/11/2022, AS will approve the request to add the school gym to the school-age license.
SUPERVISOR'S NAME: Jeanne SmithTELEPHONE: (916) 208-4405
LICENSING EVALUATOR NAME: Alecia SifuentesTELEPHONE: (916) 917-9202
LICENSING EVALUATOR SIGNATURE:
DATE: 03/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/11/2022
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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