414004699-3-12-2021-05-CC-BVAN-BZ2TMC-20210312135055

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414004699
Report Date: 03/12/2021
Date Signed: 03/12/2021 01:51:34 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 (SA)		FACILITY NUMBER:	414004699
ADMINISTRATOR:	PATEL, MELISA		FACILITY TYPE:	840
ADDRESS:	801 HOWARD AVENUE		TELEPHONE:	(650) 906-2506
CITY:	BURLINGAME,	STATE: CA	ZIP CODE:	94010
CAPACITY:	91	CENSUS: 0	DATE:	03/12/2021
TYPE OF VISIT:	Case Management - Licensee Initiated	ANNOUNCED	TIME BEGAN:	12:00 PM
MET WITH:	Brennan Bernardo and Kristy Nguyen		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	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 new Site Director, Kristy Nguyen, for a case management via Facetime. The Department received an application from the facility requesting a capacity increase. This is a School-age Program; currently, the facility is licensed for 91 School-age children and requesting an increase of capacity to 109 School-age children. The three new classrooms being added to the Program are rooms #14, #15, and #17. Rooms #14 and #15 were previously licensed for the Preschool Program(414004698). The facility has included a letter from the Chief Business Officer of Burlingame School District that permits the facility to use the mentioned rooms to be added to the license. The fire clearance was received from Burlingame Central County Fire Dept on March 9, 2021, approved for a capacity of 109 children. Per the facility sketch submitted and comment/recommendation from the approved fire clearance from the Fire Inspector. The following is maximum occupant loads for each room: Room #14 allows a maximum of 30 children. Room #15 allows a maximum of 30 children. Room #17 allows a maximum of 26 children. 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 (SA)	FACILITY NUMBER: 414004699
	VISIT DATE: 03/12/2021

NARRATIVE

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Through FaceTime video chat, LPA and Mr. Bernardo inspect all the new rooms for Health and Safety Hazards. All rooms appear clean and in good repair with sufficient lighting, ventilation, and age-appropriate toys and equipment for children. There is a fully charged fire extinguisher that meets the minimum size requirement. The facility is also equipped with carbon monoxide detectors, a centralized smoke alarm. First Aid Kit and Emergency supplies are properly maintained and kept inaccessible to children. There are cubbies available for children's belongings. The Program has exclusive/scheduled use of accessible boys' and girls' restrooms on campus. Bathrooms are clean, in good repair, and have adequate supplies.

The Program has exclusive/scheduled use of sections of the Elementary School Playground. The outdoor play area is free of debris, and hazardous materials. All outdoor toys and climbing structures are age-appropriate, in good repair.

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.

The facility is recommended for a capacity increase to 109 School-age children upon supervisor reviews and 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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