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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334807508
Report Date: 07/06/2023
Date Signed: 07/06/2023 09:51:31 AM

Document Has Been Signed on 07/06/2023 09:51 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
INLAND EMPIRE CHILD, 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: 66CENSUS: 25DATE:
07/06/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:25 AM
MET WITH:Gabriela VellascoTIME COMPLETED:
10:00 AM
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On 07/06/2023 at 9:28 AM, Licensing Program Analysts (LPAs) Raymond Moorehead and Taityana Benson, and Licensing Program Manager (LPM) Aaron Ross arrived at the facility to conduct a Case Managment visit. LPA/LPM met with Site Director Gabriela Vellasco. Ms. Vellasco granted access, census was taken, records were reviewed and children/staff were interviewed.

No violations of Title 22 Regulations were observed during today's visit.

An exit interview was held with Ms. Vellasco.
SUPERVISORS NAME: Aaron Ross
LICENSING EVALUATOR NAME: Raymond Moorehead
LICENSING EVALUATOR SIGNATURE: DATE: 07/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/06/2023
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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