<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434416994
Report Date: 10/18/2022
Date Signed: 01/23/2023 08:41:07 AM

Document Has Been Signed on 01/23/2023 08:41 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
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:KCE CHAMPIONS LLC @ DEVARGAS ELEMENTARYFACILITY NUMBER:
434416994
ADMINISTRATOR:CECELIA GIUFFRIDAFACILITY TYPE:
840
ADDRESS:5050 MOORPARK AVENUETELEPHONE:
9254577138
CITY:SAN JOSESTATE: CAZIP CODE:
95129
CAPACITY: 60TOTAL ENROLLED CHILDREN: 60CENSUS: 27DATE:
10/18/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:10 PM
MET WITH:Cecelia Giuffrida TIME COMPLETED:
04:06 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Page 1
Licensing Program Analysts (LPA) Stephanie Collins conducted an unannounced required Annual licensing inspection to the Facility today. LPA met with Site Director Cecelia Giuffrida and explained the nature of today's inspection. LPA observed 27 children and 4 staff supervising and assisting the children in care.

KCE Champions LLC. @ DeVargas Elementary School is a school age program licensed in rooms 23, 24, 31 and 32, on the active campus of
DeVargas Elementary School, Cupertino Union School District . The school age program operates Monday thru Friday from 06:30 AM to 8 AM - 2:05 PM to 6 PM (Tuesday 1:30 -6 PM) during school breaks and 8 AM-5 PM during summer programs.

LPA reviewed a percentage of children's files and all staff files during today's inspection. Each School age child's file reviewed contained the required documents; including the Information and Emergency Information form (LIC 700) and immunization records. All staff files reviewed contain the required documents; including transcripts/verification experience/ immunization records, and Health Screening Report. All staff have current certificates of completion of the Mandated Reporter Training. Director and staff member have a current CPR and First Aid certifications on file. Director understand 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).
Facility representative Cecelia Guiffrida 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.

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Stephanie Collins
LICENSING EVALUATOR SIGNATURE: DATE: 10/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/18/2022
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 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: KCE CHAMPIONS LLC @ DEVARGAS ELEMENTARY
FACILITY NUMBER: 434416994
VISIT DATE: 10/18/2022
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Page 2
LPA toured the indoor and outdoor areas of the Facility during today's inspection. LPA observed the required posted materials, including the Facility License, Emergency Disaster Plan (LIC 610), Earthquake Preparedness Checklist (LIC 9148), Parents' Rights Poster (PUB 393), Personal Rights (LIC 613A), Child Car Seat Law (PUB 269), menus, and activity schedule. LPA observed classrooms, playground areas and bathrooms during today's inspection . LPA observed appropriate chairs and tables. LPA observed a trash can with tight fitting lids and adequate equipment, furniture, and supplies for children.

The children’s bathrooms are located inside each room and throughout the DeVargas Elementary School Campus. Staff have designated bathrooms located near the main office area of the elementary school. Children who become ill can use the nurse’s station.

The program provides snacks for the school age children. Cupertino Union Schools District supplies AM and PM snacks that are delivered to the cafeteria. There is a food preparation area with hot and cold running water a refrigerator located in each classroom. Drinking water is provided via a combination of water fountains and water dispensers both indoors/outdoors. Cleaning supplies are stored in a locked cabinet inaccessible to children. Transportation will not be provided by the Facility.

The school age program can utilizes the playgrounds located throughout the elementary school campus which are fully fenced in. There are age appropriate climbing structures with sufficient resilient materials. LPA did not observe any bodies of water during today's visit. Each room has appropriate lighting and ventilation (central heating/air conditioning). First aid supplies are stored in each room inaccessible to children. LPA observed functioning smoke detector/carbon monoxide, fully charged fire extinguisher. Directors states there no weapons and ammunition being stored or allowed on the premises.

Incidental Medical Services (IMS) policy was discussed with the Applicant. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. 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. The Applicant states that he does not plan on administering medication to the day care children at this time.


SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Stephanie Collins
LICENSING EVALUATOR SIGNATURE:

DATE: 10/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/18/2022
LIC809 (FAS) - (06/04)
Page: 3 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: KCE CHAMPIONS LLC @ DEVARGAS ELEMENTARY
FACILITY NUMBER: 434416994
VISIT DATE: 10/18/2022
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Page 3

To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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/process.

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

Exit interview conducted and report was reviewed with the licensee facility representative Cecelia Giuffrida

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Stephanie Collins
LICENSING EVALUATOR SIGNATURE:

DATE: 10/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/18/2022
LIC809 (FAS) - (06/04)
Page: 2 of 3