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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434416681
Report Date: 08/09/2021
Date Signed: 08/09/2021 02:43:39 PM

Document Has Been Signed on 08/09/2021 02:43 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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:KCE CHAMPIONS LLC @ MURDOCK-PORTAL ELEMENTARYFACILITY NUMBER:
434416681
ADMINISTRATOR:JACQUELINE NAVARROFACILITY TYPE:
840
ADDRESS:1188 WUNDERLICH DRIVETELEPHONE:
(408) 665-9337
CITY:SAN JOSESTATE: CAZIP CODE:
95129
CAPACITY: 121TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
08/09/2021
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME BEGAN:
01:19 PM
MET WITH:Marcos EstradaTIME COMPLETED:
03:00 PM
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LPA Pete Hernandez conducted an announced Case Management - Other inspection of the Facility today. Direcor Marcos Estrada and explained the reason for the inspection. The program will be using the following rooms: School-age: Rooms 25 and 26. The purpose, per the School District request, the School-Age Center will be moving from the Wet Room/Library, Music/Science Room, Stage/Drama Room on a functioning school site TO class rooms numbers 25 and 26: Murdock-Portal Elementary School. A Fire Clearance was granted on 07/28/2021 by the San Jose Fire Department. Outdoor space is more than adequate for the number of children in care for the purposes of this inspection report. LPA toured and measured the indoor and outdoors of the Facility during today's inspection.

INDOOR MEASUREMENTS ARE AS FOLLOWS:
Room #25: (30.250 x 23.500) + (14 x 9) minus 17.878 (encumbered space) = 818.997
Room #26: (30.250 x 22.667) +( 9 x 13.917) minus 72.425 (encumbered space/= 738.509
TOTAL INDOOR SPACE: 818.997 + 738.509 = 1557.506 divided by 35 = 44 preschool children.

An exit interview was conducted with Director Marcos Estrada. Consistent with the updated fire clearance the relocated and renamed rooms will be updated with he license. Upon approval by Licensing Management, a license for a school-age child care center will be granted and issued to the Licensee.
SUPERVISORS NAME: Sandy Knight
LICENSING EVALUATOR NAME: Pietro Hernandez
LICENSING EVALUATOR SIGNATURE: DATE: 08/09/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/09/2021
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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