<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004581
Report Date: 08/01/2019
Date Signed: 08/09/2019 10:51:33 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:KCE CHAMPIONS LLC @ROLLINGWOODFACILITY NUMBER:
414004581
ADMINISTRATOR:BENNARDO, BRENNANFACILITY TYPE:
840
ADDRESS:2500 COTTONWOOD DRIVETELEPHONE:
(408) 771-6801
CITY:SAN BRUNOSTATE: CAZIP CODE:
94066
CAPACITY:61CENSUS: DATE:
08/01/2019
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Brennan Bennardo & Tamara Payne-AlexTIME COMPLETED:
12:10 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Pandora Huffman-Smith met with the applicant for a pre-licensing inspection. The program program will be a before and after school program that will be located on the Rollingwood Elementary School campus in classroom #15 and the multi-purpose room. The program will operate in two sessions Monday - Friday from 6:30 AM to 9:30 AM and from 11:30 AM to 6:00 PM. The rooms and the outdoor areas were inspected today for health and safety hazards.

Indoor: The classroom appears to be clean and equipped with a fire extinguisher, smoke detectors, first aid kit and a sink with water fountain for children's usage. The room is adequately furnished and there is sufficient supplies and equipment for children. All furnishing and equipment appears to be safe and in good condition. The multi-purpose room will be used for overflow and group activities. The room appears to be clean, safe and there is drinking water readily available for children. There are two bathrooms on site adjacent to classroom #15 for children's usage; the men's bathroom is equipped with 5 toilets, 6 urinals and 6 sinks, and the women's bathroom is equipped with 10 toilets and 6 sinks. The bathrooms appear to be clean, safe and no health and safety hazards were observed. The staff will use the restroom located in the staff lounge.

Outdoor: There are two play areas for children that appear to be clean and safe. There is water readily available in the outdoor area for children. No apparent health and safety hazards were observed.


Prior to licensure:
  • Fire clearance
  • Superintendents certificate is required to determine approved capacity
  • An LIC 184C was given to the applicant during the inspection and all paperwork is required prior to licensure.
SUPERVISOR'S NAME: Alma MaligTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Pandora Huffman-SmithTELEPHONE: (650)266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 08/01/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/01/2019
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 1