334841006-5-1-2023-09-CC-GCAO-CRETAJ-20230501143338

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 334841006
Report Date: 05/01/2023
Date Signed: 05/01/2023 02:33:48 PM

Document Has Been Signed on 05/01/2023 02:33 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
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME:	CHAMPIONS AT MILLER MIDDLE SCHOOL		FACILITY NUMBER:	334841006
ADMINISTRATOR:	DORA VELASQUEZ		FACILITY TYPE:	840
ADDRESS:	17925 KRAMERIA AVENUE		TELEPHONE:	(951) 789-8181
CITY:	RIVERSIDE	STATE: CA	ZIP CODE:	92504
CAPACITY:	112	CENSUS: 7	DATE:	05/01/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Gracie Castro/Dora Velasquez		TIME COMPLETED:	02:40 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	A required – 1 year inspection is being conducted as part of a compliance review. Licensing Program Analyst (LPA) Giselle Carbullido toured the school-age center, inside and out. The following was observed: The inspection consisted of reviews of the following domains: Food Service Reporting Requirements Physical Plant, Care and Supervision, Children Records, Staff Records Staffing Ratio and Capacity Personal Rights The inspection found the facility to be in compliance in these domains, except as noted on the LIC809-D. Deficiencies were not cited during this visit; a technical advisory was given. · A review of the staff records and children's records were conducted as part of this evaluation. · The licensee is asked to update the following documents and submit to licensing within 30 days: Only if changes have been made: 1. LIC 500 Personnel Report 2. LIC 610 Emergency & Disaster Plan 3. Parent Handbook/ Program Curriculum/Admission policies and procedures/ fee schedule (only if changes have been made) 4. LIC 309 Administrative Organization 5. LIC 308 Designation of Administrative Responsibility · The following items have been posted and are updated where necessary: - License, Emergency Disaster Plan (LIC610) and Earthquake Preparedness Checklist (LIC9148) - Parent’s Rights Poster (PUB393), Personal Rights (LIC613A); Child Car Seat Law, Menu · The facility is operating within the terms of the license

SUPERVISOR'S NAME: Gilbert Sena	TELEPHONE: (951) 782-4844
LICENSING EVALUATOR NAME: Giselle Carbullido	TELEPHONE: (951) 970-1904
LICENSING EVALUATOR SIGNATURE:	DATE: 05/01/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2023

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: CHAMPIONS AT MILLER MIDDLE SCHOOL	FACILITY NUMBER: 334841006
	VISIT DATE: 05/01/2023

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· This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. 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 For CCCs: Incidental Medical Services (IMS) policy was discussed
· Facility representative was reminded that all adults 18 and over living or working in the home, 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 licensed 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.
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· LPA discussed the safe sleep regulations with facility representative and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource.
· LPA also informed facility representative of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

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.

An exit interview was conducted. A notice of site visit; appeal rights and copy of this report was provided and reviewed with Facility representative, Dora Velasquez.

SUPERVISOR'S NAME: Gilbert Sena	TELEPHONE: (951) 782-4844
LICENSING EVALUATOR NAME: Giselle Carbullido	TELEPHONE: (951) 970-1904
LICENSING EVALUATOR SIGNATURE:	DATE: 05/01/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2023

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
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: CHAMPIONS AT MILLER MIDDLE SCHOOL	FACILITY NUMBER: 334841006
	VISIT DATE: 05/01/2023

NARRATIVE

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· Sign in/Sign out record was reviewed and meets regulation requirements
· A Staff member is present with current Pediatric CPR/First Aid which expires on 8/24
· Opening and closing staff member’s CPR/First Aid expires on 8/24
· Director completed Health and Safety Training on file (DV)
· Staff qualifications and files were reviewed – health screening is on file and all staff meet educational requirements and health requirements for performing assigned tasks
· Staff received on the job training for house keeping, sanitation and universal health precautions
· Each child’s file is complete
· Licensee was informed of the Department has inspection authority per Health and Safety Codes
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The Licensee was informed of their reporting requirements and is provided with the Regional Office’s Unusual Incident Reporting email mailbox: UnusualIncidentReportsDO09@dss.ca.gov

To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

· AB2370 – Lead Exposure, day care facilities, effective January 1, 2019 –
The bill requires that all Child Care Centers, operating in a building constructed before January 1, 2010, shall have their drinking water tested for excessive lead levels, on or after January 1, 2020, but no later than January 1, 2023. Child Care Centers must thereafter test their drinking water every five years after the date of the initial test. SEE LIC9102 TA technical advisory
· AB605 – Child day care facilities, birth to school-age license; Effective January 1, 2021
· AB2960 – Child care and development services, online portal – Effective June 20, 2022 - This bill requires the State Superintendent of Public Instruction (SSPI), within the California Department of Education (CDE), to develop and post on CDE's website a comprehensive child care and development services online portal for families and providers by June 30, 2022.

SUPERVISOR'S NAME: Gilbert Sena	TELEPHONE: (951) 782-4844
LICENSING EVALUATOR NAME: Giselle Carbullido	TELEPHONE: (951) 970-1904
LICENSING EVALUATOR SIGNATURE:	DATE: 05/01/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2023

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
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: CHAMPIONS AT MILLER MIDDLE SCHOOL	FACILITY NUMBER: 334841006
	VISIT DATE: 05/01/2023

NARRATIVE

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· Facility is clean, safe and sanitary and in good repair.
· Ratios were met during this inspection
· Appropriate supervision was provided during this inspection
· Classrooms are equipped with age appropriate furniture and equipment in good condition
· Classrooms are clean and free of hazards
· All materials and surface accessible to children are toxic free
· No weapons stored at the facility
· There are no bodies of water present. All wading pools or similar product must be emptied immediately after use and stored in an upright position.
· Medications are stored where inaccessible to children
· Center is equipped to isolate and care for any child who becomes ill during the day.
· Hazards are stored where inaccessible to children which include: disinfectants, cleaning solutions and other items that are dangerous to children
· All floors shall be clean and safe
· Measures are taken to keep the facility free of flies, other insects and rodents
· Toxins are locked
· Bathrooms were observed to be safe, sanitary and in operating condition- public school restrooms used.
· Playgrounds are enclosed by appropriate fences and free of hazards
· Outdoor activity areas are supplied with age and size appropriate equipment in good condition
· Food preparation area is clean and free of vermin
· Food is stored appropriately and protected from contamination
· All storage containers for solid waste, including moveable bins shall have tight-fitting covers that are kept on, and in good repair
· Uncontaminated drinking water shall be readily available both indoors and out and is provided by bottle water from Pure Life
· The areas around or under high climbing equipment, swings, slides, and similar equipment shall be cushioned with material that absorbs a fall.
· Menus shall be posted at least one week in advance in a place visible by the child’s authorized representative, dated and kept on file for 30 days, and made available upon request.

SUPERVISOR'S NAME: Gilbert Sena	TELEPHONE: (951) 782-4844
LICENSING EVALUATOR NAME: Giselle Carbullido	TELEPHONE: (951) 970-1904
LICENSING EVALUATOR SIGNATURE:	DATE: 05/01/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2023

LIC809 (FAS) - (06/04)

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