414005067-4-13-2026-05-CC-NGAA-DT4VYF-20260413165103

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414005067
Report Date: 04/13/2026
Date Signed: 04/13/2026 04:51:27 PM

Document Has Been Signed on 04/13/2026 04:51 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 SCHOOL		FACILITY NUMBER:	414005067
ADMINISTRATOR/ DIRECTOR:	SAUCEDA, CYNTHIA		FACILITY TYPE:	840
ADDRESS:	875 WEST ANGUS AVENUE		TELEPHONE:	(650) 255-0420
CITY:	SAN BRUNO	STATE: CA	ZIP CODE:	94066
CAPACITY: 120	TOTAL ENROLLED CHILDREN: 120	CENSUS: 60	DATE:	04/13/2026
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	12:30 PM
MET WITH:	Vincent Andaya/Brigette Gauthier		TIME VISIT/ INSPECTION COMPLETED:	05:05 PM

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On April 13, 2026, Licensing Program Analyst (LPA) Garcia arrived at the facility and met with staff, Vincent Andaya and later joined by site director, Brigette Gauthier for an unannounced annual inspection of the school age facility. Purpose of the inspection was explained. There were no children in care at time of arrival and 2 staff present. At approximately 2:00pm, there were 17 TK-K children. Other children arrived into the program during the inspection. The school age program operates Monday, Tuesday, Thursday and Friday from 2:00pm-6:00pm and on Wednesdays from 1:00pm-6:00pm. LPA verified the background check clearance of the adults working in the facility. Area Manager, Gesmyne Bell also joined the inspection at approximately 2:20pm.

LPA and director inspected day care areas and the outdoor space. LPA also observed facility has a combined smoke/fire and carbon monoxide detector and a fully charged fire extinguisher model 3A40BC located in the classrooms. LPA did not test the functionality of the detector due to ceiling height. The facility has a working telephone on site. All cleaning solutions, poisons, and other chemicals dangerous to the children are stored inaccessible to the children. Facility has age-appropriate furniture. Facility floor and rugs are in good repair and free of any hazards.

There are first aid supplies available with scissors and tweezers in the classroom and emergency bags. Individual items provided by the parents are labeled and stored appropriately. Per Brigette, the facility provides afternoon snacks. Water is provided through filtered water stations in the elementary school or tap, refilled as needed.

LPA observed outdoor areas and age appropriate play structures are free from health and safety hazards. The outdoor area has shaded areas for the children to rest. There are a variety of play structures on soft padding on the entire area. LPA observed that there are sheds/bins and storage areas for the toys when they're not being used.

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NAME OF LICENSING PROGRAM MANAGER: Daniel J Oquendo
NAME OF LICENSING PROGRAM ANALYST: Nathan Garcia
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 04/13/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2026

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
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: 04/13/2026

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Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test.

For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1-CCP).

Based on record review and interview, the facility was built after 2010.

According to Brigette, the facility is using Discover Champions application for sign in/out. Facility has license and all other required documents posted and visible for the public. Facility has an emergency drill log and last drill was conducted on March 10, 2026. Per staff, drills are done at least every other month rotating them between fire and earthquake drills.

LPA reviewed 7 facility staff and 4 children's files. Based on record's review, LPA observed that 4 out of 4 children's files that were reviewed are complete with child's LIC 9224 available. 1 out of the 7 staff files reviewed had a missing LIC 503 (health screening report) and facility's failure to report the change in facility director. LPA received the current director's packet during the inspection.

The Director was reminded that all adults 18 and over, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

Facility was informed that as of September 1, 2016, a person may not be employed or volunteer at a childcare facility unless he or she has been immunized against influenza, pertussis, and measles or qualifies for an exemption pursuant to Health and Safety code 1596.7995 and 1597.662.

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NAME OF LICENSING PROGRAM MANAGER: Daniel J Oquendo
NAME OF LICENSING PROGRAM ANALYST: Nathan Garcia
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 04/13/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2026

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
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: 04/13/2026

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Director is aware that all staff is required to complete Mandated Reporter Training every two years. The training can be obtained online at www.mandatedreporterca.com. LPA observed the completion certificates on file.
LPA encourages the director to frequently visit our website at www.ccld.ca.gov for licensing regulations and new updates.

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.

The medications were verified located in the school office.
Incidental Medical Services – IMS. Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

Director was advised any additional questions to call Office, M-F, 8am-5pm, 650-266-8800 or 1-844-538-8766. Website: www.cdss.ca.gov

No deficiencies cited under Title 22 during today's inspection.

A copy of this report was given with the “Notice of Site Visit” to the staff. A Notice of Site Visit must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

An exit interview was conducted, and the report was reviewed and signed by facility Site Director, Brigette Gauthier.

NAME OF LICENSING PROGRAM MANAGER: Daniel J Oquendo
NAME OF LICENSING PROGRAM ANALYST: Nathan Garcia
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 04/13/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2026

LIC809 (FAS) - (06/04)

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