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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 434416994
Report Date: 05/14/2026
Date Signed: 05/14/2026 05:14:11 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/10/2026 and conducted by Evaluator Marilou Monico
PUBLIC
COMPLAINT CONTROL NUMBER: 07-CC-20260410104236
FACILITY NAME:KCE CHAMPIONS LLC @ DEVARGAS ELEMENTARYFACILITY NUMBER:
434416994
ADMINISTRATOR:ADELA BJELEVACFACILITY TYPE:
840
ADDRESS:5050 MOORPARK AVENUETELEPHONE:
(925) 457-7138
CITY:SAN JOSESTATE: CAZIP CODE:
95129
CAPACITY:60CENSUS: 23DATE:
05/14/2026
UNANNOUNCEDTIME BEGAN:
01:13 PM
MET WITH:Adela BjelevacTIME COMPLETED:
03:30 PM
ALLEGATION(S):
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Facility does not have a full time Director on site.
INVESTIGATION FINDINGS:
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On May 14, 2026, Licensing Program Analyst (LPA), Marilou Monico, met with Site Director, Adela Bjelevac, for a follow up complaint inspection and to deliver investigation findings.

Based on information obtained through interviews with staff and children, it was determined that the Site Director, Adela Bjelevac, is not working at the facility on a full-time basis. According to Site Director, she is responsible for overseeing other school age site, which requires her to divide her time between two locations. Staff members and children confirmed that the Site Director is rarely on-site and that her visits to the facility occur infrequently. The preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED.

Per Title 22, Division 12, of the California Code of Regulations, the following deficiency is being cited (see next page).

Continuation on next page:
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Marilou Monico
LICENSING EVALUATOR SIGNATURE:

DATE: 05/14/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 5
Control Number 07-CC-20260410104236
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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 @ DEVARGAS ELEMENTARY
FACILITY NUMBER: 434416994
VISIT DATE: 05/14/2026
NARRATIVE
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Exit interview conducted and report was reviewed with Site Director, Adela Bjelevac. Appeal rights were provided.

A Notice of Site Visit was issued and must remain posted for 30 days.

------------------------END OF REPORT------------------------------------------
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Marilou Monico
LICENSING EVALUATOR SIGNATURE:

DATE: 05/14/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 07-CC-20260410104236
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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 @ DEVARGAS ELEMENTARY
FACILITY NUMBER: 434416994
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/14/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/28/2026
Section Cited
CCR
101215.1(d)
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Child Care Center Directors Qualifications and Duties - (d) The child care center director, or the substitute director..... shall be on the premises during the hours the center is in operation.

This requirement is not met as evidenced by:
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Site Director, Adela Bjelevac, submitted a portion of the required paperwork for the new director during th inspection. The remaining documents must be submitted to Licensing no later than May 28, 2026.
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Based on interviews with staff and children, the facility does not have a full-time director. This poses a potential health, safety or personal rights risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Marilou Monico
LICENSING EVALUATOR SIGNATURE:

DATE: 05/14/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/10/2026 and conducted by Evaluator Marilou Monico
COMPLAINT CONTROL NUMBER: 07-CC-20260410104236

FACILITY NAME:KCE CHAMPIONS LLC @ DEVARGAS ELEMENTARYFACILITY NUMBER:
434416994
ADMINISTRATOR:ADELA BJELEVACFACILITY TYPE:
840
ADDRESS:5050 MOORPARK AVENUETELEPHONE:
(925) 457-7138
CITY:SAN JOSESTATE: CAZIP CODE:
95129
CAPACITY:60CENSUS: 23DATE:
05/14/2026
UNANNOUNCEDTIME BEGAN:
01:13 PM
MET WITH:Adela BjelevacTIME COMPLETED:
03:30 PM
ALLEGATION(S):
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Staff uses inappropriate methods of discipline.
INVESTIGATION FINDINGS:
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On May 14, 2026, Licensing Program Analyst (LPA), Marilou Monico, met with Site Director, Adela Bjelevac, for a follow up complaint inspection and to deliver investigation findings.

Based on interviews with staff and children and evidence gathered during the investigation, on April 7, 2026, a child (C1) was provided with granola bar twice but was spitting it out. C1 was given other alternative snack options but declined them. Staff informed C1 that they could not have any more snacks because they had been repeatedly wasting them. Based on interviews with staff and children, when children waste food, teachers remind them not to waste snacks and explain why it is important. Staff and children confirmed that they have never seen a child not provided with snacks as a consequence for misbehavior.

Although the allegation may have occurred or could be valid, there is not a preponderance of evidence to prove that the alleged did or did not occur. Therefore, the allegation is UNSUBSTANTIATED.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Marilou Monico
LICENSING EVALUATOR SIGNATURE:

DATE: 05/14/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5