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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414005067
Report Date: 02/27/2025
Date Signed: 02/27/2025 04:09:14 PM

Document Has Been Signed on 02/27/2025 04:09 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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:KCE CHAMPIONS @ ALLEN ELEMENTARY SCHOOLFACILITY NUMBER:
414005067
ADMINISTRATOR/
DIRECTOR:		SAUCEDA, CYNTHIAFACILITY TYPE:
840
ADDRESS:875 WEST ANGUS AVENUETELEPHONE:
(650) 255-0420
CITY:SAN BRUNOSTATE: CAZIP CODE:
94066
CAPACITY: 28TOTAL ENROLLED CHILDREN: 28CENSUS: 6DATE:
02/27/2025
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:10 PM
MET WITH:Site Director, Evan BernsteinTIME VISIT/
INSPECTION COMPLETED:
04:25 PM
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On February 27, 2025 at approximately 3:10pm, Licensing Program Analyst (LPA) Melissa Zaragoza conducted an unannounced, case management inspection. LPA met with Facility Director, Evan Bernstein, and explained the purpose of the visit.

Present during inspection was 6 children (school age) and 2 staff members. Program operates in Allen Elementary School. Program currently operates in classroom C#106, only.

Facility requested to add the library to their licensee and submitted an application to the department on, 02/03/2025. Facility obtained a fire clearance on, 12/06/2024. Facility is currently licensed for 28 school age children. Facility requested to add the library as part of overall licensed capacity, of 28 school age children.

The afterschool program operates Monday through Friday. Facilities hours of operation are from 2:00pm to 6:00pm; and on Wednesday’s, hours of operation are from 1:00pm to 6:00pm.

LPA conducted a walk-through inspection of the library space and inspected the library, indoors and outdoors, for health and safety hazards. LPA observed appropriate furniture and equipment for enrolled children. LPA observed fire extinguisher to be fully charged. Fire extinguisher was located near the entrance door of the library. LPA observe a dual Smoke and Carbon Monoxide detector to be located inside the library. LPA was unable to test Smoke and Carbon Monoxide detector due to alarm being wired with the entire school building. The school age program is exempt from requirements for indoor and outdoor space square footage, fencing and toilet/sink ratios. No measurements were taking during the inspection.

LPAs did not observe any pools, spas or bodies of water on the school site. Facility building was constructed after 2010, and LPA was provided poof of construction details. Children will have access to water with their individual drinking water bottles that can be refilled in the water dispenser, located outside of the classroom, room C#106.
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SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Melissa Zaragoza
LICENSING EVALUATOR SIGNATURE: DATE: 02/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/27/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: KCE CHAMPIONS @ ALLEN ELEMENTARY SCHOOL
FACILITY NUMBER: 414005067
VISIT DATE: 02/27/2025
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Facility representative was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code 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.

LPA Zaragoza will approve the library to be part of the license for the childcare center, KCE Champions Allen Elementery School, as of todays date, 02/27/2025.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with facility site director, Evan Bernstein.
SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Melissa Zaragoza
LICENSING EVALUATOR SIGNATURE:

DATE: 02/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2025
LIC809 (FAS) - (06/04)
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