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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 434416994
Report Date: 05/09/2025
Date Signed: 05/09/2025 04:04:20 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/06/2025 and conducted by Evaluator Jennifer Beehler
PUBLIC
COMPLAINT CONTROL NUMBER: 07-CC-20250506105130
FACILITY NAME:KCE CHAMPIONS LLC @ DEVARGAS ELEMENTARYFACILITY NUMBER:
434416994
ADMINISTRATOR:DIANA LOZANO-VALTIERRAFACILITY TYPE:
840
ADDRESS:5050 MOORPARK AVENUETELEPHONE:
(925) 457-7138
CITY:SAN JOSESTATE: CAZIP CODE:
95129
CAPACITY:60CENSUS: 15DATE:
05/09/2025
UNANNOUNCEDTIME BEGAN:
01:40 PM
MET WITH:Alexis McGrath - Facility RepresentativeTIME COMPLETED:
04:15 PM
ALLEGATION(S):
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Facility staff left day care child unattended in a classroom
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Jennifer "Jen" Beehler conducted an unannounced 10 day complaint inspection. Upon arrival, LPA was granted access to the facility by Lead Teacher Jessica Vennero. Alexis McGrath - Facility Representative arrived 10 minutes later.

LPA conducted interviews, observed the facility and collected relevant documents. LPA observed 2 separate children enter and exit the licensed restrooms between classrooms 21 & 22 between 3:01 PM - 3:06 PM. Staff responsible for the care of children were posted on the other side of the campus and could not visually observe the children in care.

Title 22: Division 1, Chapter 12, Article 06, 12291(a)(1) states: (1)No children shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation.

Continued on Page 2
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Jennifer Beehler
LICENSING EVALUATOR SIGNATURE:

DATE: 05/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 4
Control Number 07-CC-20250506105130
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: KCE CHAMPIONS LLC @ DEVARGAS ELEMENTARY
FACILITY NUMBER: 434416994
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/09/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/12/2025
Section Cited
CCR
10229(a)(1)
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Responsibility for Providing Supervision and Care: (1)No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation.
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Staff to create a plan to manage supervision during transitions, outdoor play area and restroom time. Director to conduct training on supervision with staff and provide LPA with proof of the training along with the plan of correction.
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This requirement has not been met as evidenced by: LPA observed 2 children in a classroom and restroom without staff supervision. This poses an immediate risk to the health, safety and personal rights of children in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Jennifer Beehler
LICENSING EVALUATOR SIGNATURE:

DATE: 05/09/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 07-CC-20250506105130
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: KCE CHAMPIONS LLC @ DEVARGAS ELEMENTARY
FACILITY NUMBER: 434416994
VISIT DATE: 05/09/2025
NARRATIVE
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Due to today's investigation one Type A deficiency has been cited along with an Immediate Civil Penalty of $500. More information provided on the attached 9099-D and LIC421IM.

LPA informed Facility Representative that this report dated 05/09/2025 documents one Type A citationwhich shall be posted for 30 consecutive days as there is an immediate risk to the health, safety, or personal rights of children in care. Also, LPA informed the Facility Representative to provide a copy of this licensing report dated 05/09/2025 that documents any Type A citation to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

Exit interview conducted with Facility Representative, Alexis McGrath. Report reviewed and provided along with appeal rights.

NOTICE OF SITE VISIT PROVIDED AND MUST REMAIN POSTED FOR 30 DAYS.
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Jennifer Beehler
LICENSING EVALUATOR SIGNATURE:

DATE: 05/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 4