414004698-3-12-2021-05-CC-BVAN-BZ2RKX-20210312120615

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414004698
Report Date: 03/12/2021
Date Signed: 03/12/2021 12:07:07 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 (PS)		FACILITY NUMBER:	414004698
ADMINISTRATOR:	PATEL, MELISA		FACILITY TYPE:	850
ADDRESS:	801 HOWARD AVENUE		TELEPHONE:	(650) 906-2506
CITY:	BURLINGAME	STATE: CA	ZIP CODE:	94010
CAPACITY:	24	CENSUS: 0	DATE:	03/12/2021
TYPE OF VISIT:	Case Management - Licensee Initiated	ANNOUNCED	TIME BEGAN:	08:55 AM
MET WITH:	Brennan Bernardo and Kristy Nguyen		TIME COMPLETED:	11:45 AM

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	Due to the COVID-19 health crisis and local county orders, a tele-inspection was conducted. Licensing Program Analyst (LPA) Van met with the Area Manager, Brennan Bernardo, and the new Site Director, Kristy Nguyen, for a case management via Facetime. The purpose of the inspection was to process a decrease in capacity. The Preschool center requested to remove the currently licensed rooms #14, #15 from its license and add them to the School-age license while adding room #16 to its Program. Currently, the facility is licensed for 24 Preschool children and requesting to decrease to 12 Preschool children. The fire clearance was received from Burlingame Central County Fire Dept on March 3, 2021, approved for a capacity of 12 children. Through FaceTime video chat, LPA and Mr. Bernardo inspect room #16 for Health and Safety Hazards. Due to the inspection being done virtually, Mr. Bernardo and Ms. Nguyen measure the new classroom. The new classroom measures 864 square feet allowing for 24 children. The room appears clean and in good repair with sufficient lighting and ventilation. There is a fully charged fire extinguisher that meets the minimum size requirement. The facility is also equipped with carbon monoxide detectors. All furnishing and equipment are observed to be in good condition, and there are cubbies available for children's belongings. There is a total of 4 toilets, allowing for 60 children; a total of 6 sinks, allowing for a capacity of 90 children. The bathroom is located between rooms #16 and #17. Room #17 belongs to the school-age Program. According to Mr. Bernardo, room # 17 door with access to the bathroom will be closed during the Preschool operations hours. All sinks and toilets are only be accessed by the Preschool program. Continued on the next page...

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Brendon Van	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 03/12/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2021

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 @ WASHINGTON ELEMENTARY (PS)	FACILITY NUMBER: 414004698
	VISIT DATE: 03/12/2021

NARRATIVE

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There are no changes in the outdoor space. Based on the previous PreLicensing inspection, the outdoor play area has been sectioned off with cones. An approximation of the area is 5766 square feet, allowing for 77 PreK children. The 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.

Since the inspection was done virtually, the report was emailed to Mr. Bernardo. Mr. Bernardo was informed that a follow-up inspection would be conducted in the future, and the new classroom's re-measure might be required.

The capacity decrease will be recommended upon supervisor approval.

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Brendon Van	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 03/12/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2021

LIC809 (FAS) - (06/04)

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