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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434415370
Report Date: 12/02/2025
Date Signed: 12/02/2025 03:41:56 PM

Document Has Been Signed on 12/02/2025 03:41 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 JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:KCE CHAMPIONS LLC @ LEDESMA ELEMENTARY - PSFACILITY NUMBER:
434415370
ADMINISTRATOR/
DIRECTOR:		ILSE RICHTERFACILITY TYPE:
850
ADDRESS:1001 SCHOOLHOUSE ROADTELEPHONE:
(408) 807-7157
CITY:SAN JOSESTATE: CAZIP CODE:
95138
CAPACITY: 24TOTAL ENROLLED CHILDREN: 6CENSUS: 3DATE:
12/02/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:05 AM
MET WITH:Ilse RichterTIME VISIT/
INSPECTION COMPLETED:
12:00 PM
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On 12/02/2025, Licensing Program Analyst (LPA), Farida Raja conducted an unannounced annual/random inspection in the preschool program and met with Director, Ilse Richter. LPA explained the purpose of today’s inspection. The facility is licensed to serve 24 children ages 3-5 years in two portable classrooms located on the Ledesma Elementary School campus. LPA observed the required posted materials including program schedule and snack menu. Days and hours of operation are Monday through Friday, 8:45 AM to 12:00 PM. The two portable classrooms are used for the Preschool Program until 12 PM and the same two classrooms are used for the School Age Program from 1:30 PM -5:30 PM.

LPA toured the indoor and outdoor areas of the preschool program during today's inspection. LPA observed 3 children and 2 teachers. Facility is in compliance with teacher to children ratio requirements.

Classrooms, children's restrooms and kitchen/storage area were inspected. There is a working telephone at the facility. Disinfectants, cleaning solutions or chemicals that are dangerous to the health and safety of children were stored under sink in a closed room and are inaccessible to children. Facility has central heating/cooling for comfort of children. Furniture and equipment were age appropriate and in good condition, free of sharp, loose, or pointed parts. Restrooms for children were observed to be in safe, sanitary, and operating condition. Floors were clean and free from tripping hazards. Trash cans for solid waste were observed to have swing top covers. LPA informed Director that all containers used for storage of solid wastes, including moveable bins, shall have a tight fitting cover that is kept on; shall be in good repair; and shall be leak-proof and rodent-proof. The preschool program is a half day program and children do not nap at this facility. Director states that there are no weapons or firearms on the premises. Sick children use the bathroom in the other classroom. Staff use the office restroom in the elementary school.

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NAME OF LICENSING PROGRAM MANAGER: Gladys Kuizon
NAME OF LICENSING PROGRAM ANALYST: Farida Raja
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 12/02/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/02/2025
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 JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: KCE CHAMPIONS LLC @ LEDESMA ELEMENTARY - PS
FACILITY NUMBER: 434415370
VISIT DATE: 12/02/2025
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LPA observed 2 fire extinguishers and fire pull stations. The facility has built in smoke detector/ fire system. Log shows that the last Fire Drill was conducted on 11/07/2025 which is compliant with the six-month requirement for facilities.

Drinking water is readily available for children in each room and in the outdoor playground area via individual water bottles and refilled from the kitchen sink and other water outlets without an action level exceedance.

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 as specified in Health and Safety Code section 1597.16.

LPA verified that the lead testing was completed in accordance to the Written Directives (Interim Licensing Standards) outlined in PIN 21-21.1-CCP.

LPA referred licensee [or facility representative] to the Department website for lead: Lead Toxicity Prevention and Water Testing Information (https://www.cdss.ca.gov/inforesources/child-care-licensing/water-testing-information). LPA observed that the indoor drinking water fountain (F) with the Action Level Exceedance has been removed from the classroom.

Foods and beverages were stored safely in the kitchen area. Food storage and preparation areas were observed to be sanitary. All food and beverages that require refrigeration were observed to be stored in covered containers. The facility offers morning snack for the half day preschool program. All snacks were observed to be kept in labelled containers with the expiration date indicated on the front. Medications were observed to be stored in the kitchen area in high cabinets and inaccessible to children.

Children in the preschool program use the gated kindergarten playground located cross the elementary school campus from the preschool portables. Playground and play equipment was inspected and observed to be free of hazards. LPA observed play equipment was in good condition, age-appropriate, and has sufficient resilient materials to absorb falls. Shade is provided by building overhang. There were no bodies of water observed.

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NAME OF LICENSING PROGRAM MANAGER: Gladys Kuizon
NAME OF LICENSING PROGRAM ANALYST: Farida Raja
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 12/02/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2025
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 JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: KCE CHAMPIONS LLC @ LEDESMA ELEMENTARY - PS
FACILITY NUMBER: 434415370
VISIT DATE: 12/02/2025
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Children sign in and out procedures and logs were reviewed. Children's roster was reviewed and a copy was obtained by LPA. Three children's files were reviewed and observed to be complete with the required forms. LPA observed that the facility is operating beyond the conditions and limitations specified on the license as facility has enrolled one child (C3) who is less that 3 years old. Facility is only licensed to provide care for children ages 3 years to entry into kindergarten. Director stated that she will submit an updated Application for Child Care Centers form (LIC 200A) and indicate ages of children served as 2.5 years to entry into kindergarten.

Director and one staff file was reviewed and was observed to be complete with the required forms and training's. Director understands that there shall be at least one person, with valid CPR and First Aid certifications, on site at all times or present during off-site activities (field trips). All staff maintain valid background clearances. LPA obtained an updated Designation of Facility Responsibility (LIC 308), Emergency Disaster Plan (LIC 610) and Personnel Report (LIC 500) during today's inspection.

Director 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.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. Per Director, no preschool children require medications or IMS at this time. 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: https://www.ada.gov/resources/child-care-centers/

Isolation of sick child was discussed, and Director explained that sick children is isolated in a separate classroom and isolation equipment will be provided. Child is always under visual supervision while in care of the facility. A children's restroom which is off limits to other children is used if necessary.

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NAME OF LICENSING PROGRAM MANAGER: Gladys Kuizon
NAME OF LICENSING PROGRAM ANALYST: Farida Raja
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 12/02/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2025
LIC809 (FAS) - (06/04)
Page: 4 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: KCE CHAMPIONS LLC @ LEDESMA ELEMENTARY - PS
FACILITY NUMBER: 434415370
VISIT DATE: 12/02/2025
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Facility does not provide transportation to children. Director 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.

No deficiencies were cited as a result of today's inspection. Appeal rights were printed and provided to Director.

Exit interview conducted and report was reviewed with Director, Ilse Richter.

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

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 https://www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process
NAME OF LICENSING PROGRAM MANAGER: Gladys Kuizon
NAME OF LICENSING PROGRAM ANALYST: Farida Raja
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 12/02/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2025
LIC809 (FAS) - (06/04)
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