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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334807508
Report Date: 02/02/2023
Date Signed: 02/02/2023 02:59:45 PM

Document Has Been Signed on 02/02/2023 02:59 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, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:KCE CHAMPIONS LLC @ TOMAS RIVERA ELEMENTARYFACILITY NUMBER:
334807508
ADMINISTRATOR:MARI WALSHFACILITY TYPE:
840
ADDRESS:20440 RED POPPY LANETELEPHONE:
(951) 653-9477
CITY:RIVERSIDESTATE: CAZIP CODE:
92508
CAPACITY: 66TOTAL ENROLLED CHILDREN: 50CENSUS: 26DATE:
02/02/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:Desiree Padilla, SIte DirectorTIME COMPLETED:
03:05 PM
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On 02/02/2023, Licensing Program Analyst (LPA) Kay Turner arrived at the facility on a case management visit to follow-up on an unusual incident report submitted by the facility on 01/23/2023. At the time of visit, LPA toured the facility, took census, and met with Site Director, Desiree Padilla, to discuss the reported incident. During the visit, LPA also spoke with the Teacher who witnessed the incident as it took place. There was no subject child involved in any incident.

Based on the information obtained during the visit, as well as an inspection of the facility records, there appeared to be no violations of Title 22 Regulations pertaining to the reported incident.

An exit interview was held with Site Director, Desiree Padilla. A Notice of Site visit was issued, along with a copy of this report. This report shall be public record for three years.
SUPERVISORS NAME: Aaron Ross
LICENSING EVALUATOR NAME: Karrene Turner
LICENSING EVALUATOR SIGNATURE: DATE: 02/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/02/2023
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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