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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 406215806
Report Date: 08/27/2021
Date Signed: 08/27/2021 03:30:13 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME:KCE CHAMPIONS LLC @ TEMPLETON ELEMENTARYFACILITY NUMBER:
406215806
ADMINISTRATOR:TAMARA PAYNE-ALEXFACILITY TYPE:
840
ADDRESS:215 EIGHTH STREETTELEPHONE:
(408) 348-1610
CITY:TEMPLETONSTATE: CAZIP CODE:
93465
CAPACITY:31CENSUS: 19DATE:
08/27/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Lily RuelasTIME COMPLETED:
03:30 PM
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On 8/27/2021 at 2:30 PM, Licensing Program Analyst (LPA) Gigi Reyes conducted an unannounced Case Management Inspection to deliver the Evaluation Facility Report from the annual required inspection conducted on 8/26/2021.

LPA met with Site Supervisor Lily Ruelas and teacher Kylee Degnan. There were 19 day care children present..

No deficiencies cited during the inspection.

Exit interview was conducted with Site Supervisor, Lily Ruelas. THE NOTICE OF SITE VISIT WAS POSTED AS REQUIRED BY H&S CODE SEC. 1596.817. THE NOTICE OF SITE VISIT MUST REMAIN POSTED FOR 30 DAYS OR A CIVIL PENALTY OF $100.00 WILL BE ASSESSED.

SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Gigi ReyesTELEPHONE: (805) 698-7114
LICENSING EVALUATOR SIGNATURE:

DATE: 08/27/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/27/2021
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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