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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004697
Report Date: 01/24/2025
Date Signed: 01/24/2025 03:28:00 PM

Document Has Been Signed on 01/24/2025 03:28 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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:KCE CHAMPIONS LLC @ MCKINLEY ELEMENTARY (SA)FACILITY NUMBER:
414004697
ADMINISTRATOR/
DIRECTOR:		NATHASIA ARADANASFACILITY TYPE:
840
ADDRESS:701 PALOMA AVENUETELEPHONE:
(650) 906-1762
CITY:BURLINGAMESTATE: CAZIP CODE:
94010
CAPACITY: 140TOTAL ENROLLED CHILDREN: 140CENSUS: 0DATE:
01/24/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:50 PM
MET WITH:Lead teacher, Andres CheungTIME VISIT/
INSPECTION COMPLETED:
03:55 PM
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On January 24, 2025, at approximately 12:50 PM, Licensing Program Analyst (LPA) Melissa Zaragoza conducted an unannounced, annual inspection. LPA met with the lead teacher, Andres Cheung, and explained the purpose of the visit.

KCE Champions Mckinley is a school age program. School age program is located inside the school grounds of Mckinley Elementary School. School age program has 3 classrooms licensed, RM #20, RM #17, and the library. Room #20 is the 3rd through 5th grade class, the library is the 1st through 2nd grade class, and RM#17 is the TK and Kinder class.

Hours of operation are Monday through Friday 7:00am to 9:00 am and 3:00pm to 6:00pm. Present during LPA's visit was the lead teacher, 0 school age children, and 10 teachers. School age program is operating within capacity limits and ratio during LPA's visit.

LPA inspected facility, indoors and outdoors, for health and safety hazards. Classrooms includes a variety of equipment and materials that were in good condition. LPA observed classroom to have age-appropriate furniture, equipment, and materials. LPA observed no cleaning materials or poisonous items accessible to children in care, in classrooms.

Per director, children to do not sleep while they are in the program. Children bring their water bottles from home and can refill their water bottles with the water filters inside the classrooms.

Classrooms are equipped with a fully charged fire extinguisher and first aid kits. LPA observed Carbon monoxide detector and smoke detector. Carbon monoxide detector and smoke detector were unable to get tested, due to alarms being wired with the entire school building. Storage for children's belongings is inside the classrooms. LPA observed children to have their own individual cubby. Cubbies were observed to have each children’s individual name on it.

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SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Melissa Zaragoza
LICENSING EVALUATOR SIGNATURE: DATE: 01/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/24/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: KCE CHAMPIONS LLC @ MCKINLEY ELEMENTARY (SA)
FACILITY NUMBER: 414004697
VISIT DATE: 01/24/2025
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There is one bathroom’s children can use. There is a boy’s bathroom, that was observed to have 1 stall, 3 sinks, and 1 urinal. There is one girl’s bathroom, that was observed to have 3 stalls and 3 sinks. Bathrooms for children were observed to be clean. The sinks and toilets were in working condition. LPA observed no cleaning solutions, poisons, and other hazardous materials for to be accessible to children in the bathroom.

Program provides a food service of snack only. Snack that is provided from the childcare center. Per lead teacher, children eat outside in the lunch areas. Lunch areas were observed to have benches for children to sit and eat. There are trash cans for children to throw away their food once they are done eating. LPA observed roof sunshade installed, over the lunch benches for shade.

Facility has an outdoor space area. Outdoor was entirely enclosed and fenced. LPA observed outdoor play area to have a play structure with fake grass flooring, a basketball court, and blacktop space area for children to use. LPA observed play areas to be clean and maintained in good condition.

Program uses a form to sign in and out for their sign in/sign out system. Per lead teacher, staff members sign children in and out, and parents sign children in and out. LPA observed licensing posters and required documents to be properly posted in the class. Program’s last disaster drills was conducted on October, 2024.
LPA reviewed 10 facility staff records. LPA reviewed 6 random children facility records which were complete and had all required documents. Children's records have emergency information on file. Staff on site have a current CPR/First Aid certification. Lead teacher was reminded mandated reporter training must be renewed every two years. Facility was cited one Type B deficiency for expired and missing mandated reporter training certificates. Lead teacher was reminded staff files must include required immunizations for all staff working with children. Facility was cited one technical violation for staff missing immunizations on file.

Director was reminded all staff hired are required to complete Mandated Reporter Training every two years. The training can be obtained online at www.mandatedreporterca.com.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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/inspection-process

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SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Melissa Zaragoza
LICENSING EVALUATOR SIGNATURE:

DATE: 01/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2025
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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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: KCE CHAMPIONS LLC @ MCKINLEY ELEMENTARY (SA)
FACILITY NUMBER: 414004697
VISIT DATE: 01/24/2025
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Director was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test. For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1-CCP). LPA verified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP.

Per lead teacher, facility does prepare food at the facility. Childcare center has not submitted an attestation letter to the department.

LPA's discussed the safe sleep regulations with director and discussed the Child Care Licensing Safe Sleep webpage athttps://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep as an additional resource. LPA also informed director of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see PIN 22-02-CCP. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514-0383 (TTY) and link to publication. Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/.

Director was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

Program was cited a Type B citation for not completing lead water testing requirement by due date of January 2023 or submitted an attestation letter to the department. Appeal Rights were provided.

Please see LIC 809-D for deficiencies cited today.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the lead teacher, Andres Cheung.
SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Melissa Zaragoza
LICENSING EVALUATOR SIGNATURE:

DATE: 01/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2025
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 01/24/2025 03:28 PM - It Cannot Be Edited


Created By: Melissa Zaragoza On 01/24/2025 at 03:08 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: KCE CHAMPIONS LLC @ MCKINLEY ELEMENTARY (SA)
FACILITY NUMBER: 414004697

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/24/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1597.16(a)(1)
Lead Testing
(1) A licensed child day care center, as defined in Section 1596.76, that is located in a building that was constructed before January 1, 2010, shall have its drinking water tested for lead contamination levels on or after January 1, 2020, but no later than January 1, 2023, and every five years after the date of the initial test.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and record review, the licensee did not comply with the section cited above by not submiting an attestation letter to the department which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/24/2025
Plan of Correction
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Per lead teacher, they will speak with the director in regards to either testing for lead water or submitting an attestation letter to the department.
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and record review, the licensee did not comply with the section cited above many staff have a expired mandated reporter certificate on file which posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/07/2025
Plan of Correction
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Per lead teacher, they will have staff complete their Mandated Reporter training certificate and will submit proof to LPA, once all staff have renewed training.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Marie Rodriguez
LICENSING EVALUATOR NAME:Melissa Zaragoza
LICENSING EVALUATOR SIGNATURE:
DATE: 01/24/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/24/2025


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