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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414005276
Report Date: 06/09/2026
Date Signed: 06/09/2026 01:50:05 PM

Document Has Been Signed on 06/09/2026 01:50 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 LLC @ BELLE AIR ELEMENTARYFACILITY NUMBER:
414005276
ADMINISTRATOR/
DIRECTOR:		JEREMY KATTERHORNFACILITY TYPE:
860
ADDRESS:450 3RD AVENUETELEPHONE:
(669) 298-7357
CITY:SAN BRUNOSTATE: CAZIP CODE:
94066
CAPACITY: 120TOTAL ENROLLED CHILDREN: 120CENSUS: 0DATE:
06/09/2026
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:10 AM
MET WITH:Gesmyne Bell/Jeremy KatterhornTIME VISIT/
INSPECTION COMPLETED:
02:05 PM
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On June 9, 2026 at approximately 10:00am, Licensing Program Analyst (LPA) Garcia conducted an announced, pre-licensing visit. LPA met with applicant, Gesmyne Bell and site supervisor, Jeremy Katterhorn.

Program is currently operating as a license exempt, "ELOP" program. Applicant plans to operate as a licensed program once license has been obtained. This is an initial application that was submitted July 24, 2025. Applicant is requesting for a total capacity of 120 children: all school age children (ages 4-12 years old). Fire inspection for 120 children occurred on January 7, 2026.

The Champions after school program will operate at Belle Air Elementary School. The program will operate Monday through Friday after school only from 1:00pm to 6:00pm. School age program will operate in classroom #21, library and the Multi-use room. LPA inspected indoor and outdoor areas for health and safety hazards.
The school age program is exempt from requirements for indoor and outdoor square footage, fencing, and toilet/sink ratios. No measurements were taken during LPA's visit.

LPA observed classrooms to have a variety of toys and materials. Flooring includes carpet that was observed to be clean and in good condition. There are closets throughout the facility that are locked, inaccessible to children. LPA observed children's furniture and equipment to be in good condition. LPA observed the garbage bins with tight fitting lids in each classroom. Per site supervisor, children's toys and materials will be wiped and sanitized daily and deep cleaned by utilizing the school district cleaning services. Per staff, the facility will communicate with parents by email and by phone with a land line phone on site.

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NAME OF LICENSING PROGRAM MANAGER: Daniel J Oquendo
NAME OF LICENSING PROGRAM ANALYST: Nathan Garcia
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 06/09/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/09/2026
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 5
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 LLC @ BELLE AIR ELEMENTARY
FACILITY NUMBER: 414005276
VISIT DATE: 06/09/2026
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Classrooms include areas for playing, and group work. There is sufficient cubby space for children's personal belongings. LPA observed that there are books and other learning materials available for the children.
LPA observed and tested toilets and sinks to be in working condition. LPA also observed children's restroom and classroom sinks do not provide hot water. LPA observed garbage bins with tight fitting lids in the children's restrooms. There is a sink in the classroom that applicant plans to use for hand washing only. Champions program will have access to three sets of bathrooms on site. Bathroom was observed to be clean and in proper working condition. LPA observed bathrooms to allow for individual privacy.

Per program director, the designated isolation area for sick children will be the corner of classroom 21, in the reading area and another area can be utilized near the elementary school office.

LPA observed classroom to be equipped with a fully charged fire extinguisher, fire sprinklers, fire alarm system. LPA observed there are no carbon monoxide detectors on site and staff was reminded to obtain the detectors. Classroom is also equipped with a fully stocked first aid kit. Applicant plans for medications with required authorization and licensing documentation will be stored in the classroom cabinets, in a locked box. Storage for children's belongings are located inside the classroom.

According to applicant, licensing documents will be posted and available for review. According to applicant, children will be signed in and out of program using "Discover Champions" application with specific parent codes, but not including their signatures.

Program will provide dry, afternoon snacks only. Food will be stored in cabinets/bins that does not contain toxins or poisons in the classroom. Water is accessible to enrolled children with a refillable water station in the multi-use room and a water fountains in the classroom and outdoor area. Champions program plans to utilize room 21 for children ages Tk/K/1st grade and the Multi-use room for 2nd grade to 5th grade.

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NAME OF LICENSING PROGRAM MANAGER: Daniel J Oquendo
NAME OF LICENSING PROGRAM ANALYST: Nathan Garcia
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/09/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2026
LIC809 (FAS) - (06/04)
Page: 3 of 5
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 LLC @ BELLE AIR ELEMENTARY
FACILITY NUMBER: 414005276
VISIT DATE: 06/09/2026
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This facility plans to provide Incidental Medical Services – IMS. For IMS information, see PIN 22-02-CCP. A Plan of Operation that includes 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) or (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 entire outdoor area of the school is enclosed by a fence. Champions program has access to entire outdoor area that include multiple play structures, field, basketball court and outdoor staging/picnic bench area. LPA observed playgrounds with play structures to have tan bark. Outdoor area is clean and free of any loose debris or materials. There's shade from the buildings and trees in the outdoor area. LPA did not observe any pools, spas or bodies of water on site.

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).

LPA reviewed with director the LIC 311A, Records to be Maintained at the Facility, for child’s records, personnel records, administrative records, and documents to be posted. Entrance Checklist was provided to the director.

Director was informed of the MyChildCarePlan.org site, a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters, and other important information communication platforms.

LPA reminded staff that disaster drills are conducted at least once every 6 months and must be properly logged and documented. Discipline policy was discussed and program plans to communicate and utilize the Champions Positive Behavior Support manual.

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NAME OF LICENSING PROGRAM MANAGER: Daniel J Oquendo
NAME OF LICENSING PROGRAM ANALYST: Nathan Garcia
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/09/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2026
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 BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: KCE CHAMPIONS LLC @ BELLE AIR ELEMENTARY
FACILITY NUMBER: 414005276
VISIT DATE: 06/09/2026
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To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/communitycare-licensing/subscribe and select the Child Care option to receive email communication.

Applicant was reminded that all adults 18 and over responsible for administration or direct supervision of staff, persons who provides care and supervision to children, and staff who have contact with children, 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.

If you have any questions regarding the process or CARE tools, please send email inquiries to [email protected]. 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

Applicant was reminded that any changes to the facility must be reported to and approved by Community Care Licensing.

A license for 120 children will be approved when the following is complete:


-Posting of licensing documents.
-Carbon Monoxide detectors in each rooms.
-Outdoor schedule waiver request for the Tk-1st grade that is shared space with the elementary preschool program.
-Centralized Application Bureau (CAB) final approval of application.

Exit interview conducted and report was reviewed with the applicant, Gesmyne Bell.
NAME OF LICENSING PROGRAM MANAGER: Daniel J Oquendo
NAME OF LICENSING PROGRAM ANALYST: Nathan Garcia
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/09/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2026
LIC809 (FAS) - (06/04)
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