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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004697
Report Date: 09/29/2021
Date Signed: 09/29/2021 01:45:13 PM

Document Has Been Signed on 09/29/2021 01:45 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, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:KCE CHAMPIONS LLC @ MCKINLEY ELEMENTARY (SA)FACILITY NUMBER:
414004697
ADMINISTRATOR:NAJJAR, SHEREENFACILITY TYPE:
840
ADDRESS:701 PALOMA AVENUETELEPHONE:
(650) 906-1762
CITY:BURLINGAME,STATE: CAZIP CODE:
94010
CAPACITY: 140TOTAL ENROLLED CHILDREN: 0CENSUS: 19DATE:
09/29/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Shereen NajjarTIME COMPLETED:
02:30 PM
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On September 29, 2021, Licensing Program Analyst (LPA) Van met with the Director, Shereen Najjar, and KCE Champions, Area Manager, Brennan Bennardo, for an unannounced annual inspection. The purpose of the inspection was explained. This facility is a school-aged after-school program that operates in the McKinley Elementary School in Burlingame. The days and hours of operations are Monday- Friday, the morning program is from 7:00 am – 9:00 am, and the afternoon program is from 2:00 pm - 6:30 pm. Today in the morning, seven staff including the Director, were supervising 19 children.

LPA, along with the Director, inspected the facility for health and safety hazards. A variety of age-appropriate furnishing and learning materials for children are available in the classroom. There are no pools, spas, or other bodies of water at the facility. The facility has a centralized smoke detector, carbon monoxide detector in each classroom, fully charged fire extinguishers, and a working telephone. All cleaning solutions, poisons, and other dangerous chemicals are stored in an area inaccessible to children. Sick children will be separated from the group and waited in the Director's office for parents to pick them up. The facility is in good repair and free of any hazards with proper temperature and ventilation. All the bathrooms, toilets, and sinks are clean and well sanitized. All solid waste bins have a suitable tight-fitted lid on top, and the facility has a water dispensary readily available for children. The outdoor playground area is in good repair.
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Brendon Van
LICENSING EVALUATOR SIGNATURE: DATE: 09/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/29/2021
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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 @ MCKINLEY ELEMENTARY (SA)
FACILITY NUMBER: 414004697
VISIT DATE: 09/29/2021
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In today's inspection, LPA reviewed ten random samples of children's records and seven staff records. According to the Director, the teacher assigned to the Kindergarten and 1st graders will come to the children's classroom and pick them up. The designated teacher for second–graders to fifth–graders will be positioned in the yard, and the children will meet the teacher there. The teacher will sign in all children, and a head count will be conducted prior to entering the classroom. All children had a medical assessment, and required licensing forms were completed. All staff has criminal record clearance. The staff has a record of valid Pediatric FirstAid/CPR card in the file and the required immunization. LPA also observed that the facility had posted the required forms. (i.e., License, waivers, Notification of Parent's Rights, and Notification of Personal Rights). The Director stated that Fire and Earthquake drills are once every 6 months, and the last exercise was conducted on September 24.

LPA reminded the Director that as of September 1, 2016. A person may not be employed or volunteer at a childcare facility unless he or she has been immunized against influenza, pertussis, and measles. LPA observed that the facility has a record of required immunization of all staff.

Incidental Medical Services (IMS) policy was discussed. For IMS information, see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. 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
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Brendon Van
LICENSING EVALUATOR SIGNATURE:

DATE: 09/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2021
LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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 @ MCKINLEY ELEMENTARY (SA)
FACILITY NUMBER: 414004697
VISIT DATE: 09/29/2021
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The Director 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.

The Director was informed about Mandated Reporter training available on the CCLD website. In addition to AB1207 training required to complete every two years by all staff hired, a one-time General Training is also required. Training can be taken online at www.mandaterreporterca.com. Also, the Director was reminded of Pesticides training. Information on the DPR website at: www.cdpr.ca.gov/shoolipm/childcare. LPA encouraged the Director to frequently visit the CCLD website at www.ccld.ca.gov for licensing regulations and new updates. The Director can also email at childcareadvocatesprogram@dss.ca.gov and ask to be added to the email list for the updates.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

No deficiencies were cited today. An exit interview was conducted, and the report was reviewed with the Director, Shereen Najjar. Today's report, 9/29/2021, and notice of site visit will be sent to the Director by email at Shereen.Najjar@discoverchampions.com by the close of business on 9/29/21. Confirmation of receipt is required. LPA informed the Director that the notice of site visit must be posted for 30 days.
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Brendon Van
LICENSING EVALUATOR SIGNATURE:

DATE: 09/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2021
LIC809 (FAS) - (06/04)
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