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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 406206847
Report Date: 05/12/2026
Date Signed: 05/13/2026 09:02:13 AM

Document Has Been Signed on 05/13/2026 09:02 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
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME:KCE CHAMPIONS LLC @ SAN BENITOFACILITY NUMBER:
406206847
ADMINISTRATOR/
DIRECTOR:
DAWN MARTINFACILITY TYPE:
840
ADDRESS:4300 SAN BENITOTELEPHONE:
(805) 975-6105
CITY:ATASCADEROSTATE: CAZIP CODE:
93422
CAPACITY: 58TOTAL ENROLLED CHILDREN: 58CENSUS: 3DATE:
05/12/2026
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:15 PM
MET WITH:Tyler MarettiTIME VISIT/
INSPECTION COMPLETED:
02:15 PM
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On 5/12/26, at 12:15 PM, Licensing Program Analyst (LPA) Matthew Sapien conducted an annual random inspection of the abovementioned Child Care Center (CCC). LPA met with Tyler Maretti, Site Supervisor of the CCC, and explained the purpose of the inspection. LPA toured the entirety of the the CCC (interior and exterior). The CCC is on the grounds of San Benito Elementary School. The CCC utilizes two modular classrooms (Classroom 1006 and 1007), two school playgrounds, and three sets of school restrooms. Site Supervisor informed LPA that bathrooms and playgrounds are used at staggered times so children at the CCC don't commingle with school-attending children. The playgrounds are used by the CCC when the school is dismissed for the day.

The CCC operates Monday through Friday spanning from 7:00 AM until 8:00 AM, 11:40 AM until 2:30 PM, and 2:30 PM until 6:00 PM. Importantly to note, there are three cohorts of children that attend the CCC. At the time of the inspection, LPA observed 3 children in care and 2 additional staff members (cleared and associated). At 1:30 PM, an additional staff member arrived at the CCC (cleared and associated)

The classrooms of the CCC are clean and orderly. The classrooms have age-appropriate equipment and furnishings for children in care. The classrooms contain a number of closets and storage spaces all of which contain items, equipment, and other related objects for children in care. The bathrooms, located on school grounds, were found to be clean and orderly. CCC staff informed LPA that children are escorted to the restrooms and that the restrooms are only being used by the CCC children at times of use.

The CCC possesses an operational mini-refrigerator in classroom 1007. The fridge possesses food items for staff and children in care. The CCC distributes two snacks for each cohort of children in care. The TK cohort of children are the only ones that bring lunches from home. Like snacks, drinking water is also available for children via a five-gallon water dispenser. Children bring reusable water bottles from home, however, cups are also available on site for children in care in the event that a child doesn't have a bottle.

CCCs constructed before 1/1/20, are supposed to test their water (used for drinking and food preparation) for lead contamination before 1/1/23, and then every 5-years except after the date of the first test. For child care center licenses issued after 7/1/22, the licensee shall test their water for lead within 180 days of (CONT. LIC 809-C, Page 2)

NAME OF LICENSING PROGRAM MANAGER: Maria Mueller
NAME OF LICENSING PROGRAM ANALYST: Matthew Sapien
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 05/12/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/12/2026
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: KCE CHAMPIONS LLC @ SAN BENITO
FACILITY NUMBER: 406206847
VISIT DATE: 05/12/2026
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This facility does not currently provide Incidental Medical Services – IMS. For IMS information see PIN 22-02-CCP. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514-0383 and link to publication Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/.

Facility Representative was reminded that all adults 18 and over, including employees and volunteers, as specified in HSC section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

Facility Representative was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

During today's visit, no citations were issued.

During the exit interview, the Facility Representative confirmed that there are no Registered Sex Offenders in the facility when the LPA completed an RSO profile in FAS on 5/12/26.

Facility Representative was provided with Appeal Rights (LIC 9058) and a Notice of Site Visit (LIC 9213). The Notice of Site Visit form must be posted for 30 days or a civil penalty of $100 may apply.

An exit interview was conducted, and the report was reviewed with Facility Representative,Tyler Maretti .

NAME OF LICENSING PROGRAM MANAGER: Maria Mueller
NAME OF LICENSING PROGRAM ANALYST: Matthew Sapien
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/12/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2026
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
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: KCE CHAMPIONS LLC @ SAN BENITO
FACILITY NUMBER: 406206847
VISIT DATE: 05/12/2026
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licensure pursuant to Written Directives section 101700 (PIN 21-21.1-CCP). Through interview and record review, LPA confirmed that the CCC is current on written directives outlined in section 101700. Lead testing was conducted and completed in late June of 2023.

LPA observed snack menus, daily routine schedules, required notices, and other relevant licensing documents posted prominently in the classrooms. At the CCC, children's sign in and sign out sheets are completed on paper and through Discover Champions (online application). LPA found that the CCC completed their most recent disaster drill on 5/7/26. Facility Representative informed LPA that the CCC conducts disaster drills at least once and sometimes twice every month.

In classroom 1007, a carbon monoxide detector was tested at 12:25 PM and was found to be operational. In classroom 1006, a carbon monoxide detector was tested at 12:32 PM and was found to be operational. The CCC's smoke detectors were not tested by the LPA as the CCC's smoke detectors are integrated into the classroom's fire detection systems. In the classrooms, cleaning supplies are stored beneath the sinks in locked cabinets and in an elevated cabinets as well. Sharps, like scissors, were observed to be placed in teacher's filing cabinets, which are areas that children do not wander in. A lockbox for medication is stored in an elevated classroom cabinet (classroom 1007). LPA also viewed a First Aid Kit backpack in the CCC. The First Aid Kit backpack was observed to contain appropriate supplies like hydrogen peroxide, band aids, and other appropriate supplies.

As mentioned prior, the CCC uses two playgrounds for outdoor play. The outside playground areas are enclosed by chain linked fencing throughout. The fence’s entry and exit gates in the yard are secure and furnishings in the area are age appropriate. The play equipment is free of sharp, loose, or pointed objects. The play structures in the outdoor playground areas have adequate cushioning to absorb falls (sand and wood chips). The surface of the outdoor playground area is varied. The areas are made up of asphalt, concrete pavement, natural grass, and dirt. Shade is provided by trees and building overhangs. Older children also have access to a lower field, ball walls, and basketball courts. LPA reminded the Facility Representative of the responsibility of active supervision over children in care while engaged in outdoor play. Site Supervisor informed LPA that children only have access to a portion of the grass area which allows for better supervision of the children. Facility Representative attested to LPA that children are always supervised while outside and that the outdoor area is inspected prior to letting children outside.

A sampling of staff and children's records were reviewed. The children’s records were complete and were found to contain emergency contact information as well admission agreements, among other relevant licensing documents and forms. Staff records were reviewed and contained current pediatric CPR and First Aid certifications (EMSA approved) and Mandated Reporter Training certificates among other relevant licensing documents. LPA confirmed that there are no bodies of water, firearms, or ammunition that are on site. (CONT. 809-C, Page 3)

NAME OF LICENSING PROGRAM MANAGER: Maria Mueller
NAME OF LICENSING PROGRAM ANALYST: Matthew Sapien
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/12/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2026
LIC809 (FAS) - (06/04)
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