414004698-10-1-2020-05-CC-CINO-BTYTZH-20201001151022

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414004698
Report Date: 08/20/2020
Date Signed: 10/01/2020 03:11:06 PM

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 @WASHINGTON ELEMENTARY		FACILITY NUMBER:	414004698
ADMINISTRATOR:	BENNARDO, BRENNAN		FACILITY TYPE:	850
ADDRESS:	801 HOWARD AVENUE		TELEPHONE:	(408) 771-6801
CITY:	BURLINGAME	STATE: CA	ZIP CODE:	94010
CAPACITY:	24	CENSUS: 0	DATE:	08/20/2020
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Area Manager, Brennan Bennardo and Site Supervisor, Melisa Patel		TIME COMPLETED:	02:00 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), Cindy Interiano conducted a PreLicensing inspection and met with Area Manager, Brennan Bennardo and Site Supervisor, Melisa Patel via a Tele-Inspection. Purpose of the inspection was explained to Area Manager and Site Supervisor. No children were present during the inspection. First day of school is scheduled for 08/26/20. Facility has requested a license capacity of 24 Preschool children ages 3-5 years old. Days and hours of operation: Mon-Fri, 8:00am-1:30pm. Area Manager and Site Supervisor lead LPA on a virtual inspection of the facility indoors and outdoors for Health and Safety hazards. Per facility sketch, > Room #14 measures 967 square feet, allowing for 27 PreK children. > Room #15 measures 867 square feet, allowing for 25 PreK children. > Room #14 and #15 each have 1 restroom with 1 toilet and 1 sink, with a total of 2 toilets and 2 sinks for children’s use. > Outdoor play area has been sectioned off with cones. An approximation of the area is of 5766 square feet, allowing for 77 PreK children. Outdoor play area will be shared with School age children, however Program will ensure there is no co-mingling of Preschool children with School Age children, unless on special/rare occasions. See facility sketch and capacity worksheet. Each classroom has sufficient toys, cubbies, and equipment for children. Each classroom has a working telephone, smoke and carbon monoxide detector and a fire extinguisher. Drinking water is readily available for children. Each classroom has a fully supplied Emergency kit backpack. Area for an ill child will be in a quiet area in the classroom with use of children’s restroom, which will be disinfected after every use. Children’s medication will be kept in an inaccessible cabinet in the child’s assigned classroom. Facility will be providing snacks and children will bring their own meals. All mandatory postings are posted in each classroom, including menus. See Page 2. . .

SUPERVISOR'S NAME: Alma Malig	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Cindy Interiano	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 08/20/2020

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2020

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 @WASHINGTON ELEMENTARY	FACILITY NUMBER: 414004698
	VISIT DATE: 08/20/2020

NARRATIVE

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Page 2. . .

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

Facility was informed that as of September 1, 2016, a person may not be employed or volunteer at a child care facility unless he or she has been immunized against influenza, pertussis, and measles or qualifies for an exemption pursuant to Health and Safety code 1596.7995 and 1597.662.

Area Manager and Site Supervisor were informed about the Provider Information Notices (PINs) on CCLD website.

Area Manager and Site Supervisor were advised of Mandated Reporter Training available on CCLD website.

During the tele-inspection, LPA provided Technical Assistance for Covid-19 guidelines, including Social Distancing, proper use of PPE equipment, and cleaning / disinfecting / sanitizing of commonly used areas/items.

Area Manager and Site Supervisor were advised that a follow-up inspection will be conducted in the future and measurement of indoor and outdoor space will be required.

Fire Clearance dated 07/28/20 has been granted for 24 Preschool age children.

Prior to approving license for a capacity of 24PreK children,
>Final review is required from the Department.

>This report will be emailed to facility. This report must be available in the facility for public review. Any additional questions to call Office, M-F, 8a-5p, 650-266-8800 or 1-844-538-8766. Website: www.ccld.ca.gov

SUPERVISOR'S NAME: Alma Malig	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Cindy Interiano	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 08/20/2020

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2020

LIC809 (FAS) - (06/04)

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