343603532-3-29-2023-53-CC-NMAS-CQDU3S-20230329151358

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 343603532
Report Date: 03/16/2023
Date Signed: 03/29/2023 03:14:34 PM

Document Has Been Signed on 03/29/2023 03:14 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
SACRAMENTO SOUTH, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833

FACILITY NAME:	CHAMPIONS @ MARENGO RANCH ELEMENTARY		FACILITY NUMBER:	343603532
ADMINISTRATOR:	MCNAIRN, JANET		FACILITY TYPE:	840
ADDRESS:	1000 ELK HILLS DR.		TELEPHONE:	(209) 745-8737
CITY:	GALT	STATE: CA	ZIP CODE:	95632
CAPACITY: 50	TOTAL ENROLLED CHILDREN: 50	CENSUS: 13	DATE:	03/16/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	02:30 PM
MET WITH:	Stacey Wakefield		TIME COMPLETED:	05:30 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	Licensing Program Analyst Katy Maestas (LPA) conducted a field visit to the facility for the purpose of an unannounced annual inspection. LPA disclosed the purpose of the inspection and was granted entrance into the facility. LPA met with the Site Supervisor Stacey Wakefield (S1). LPA toured the facility inside and outside. LPA observed 13 school aged children being supervised by 3 staff members. S1 stated that children arrive at the facility at approximately 2:30 PM. LPA accessed Guardian to verify that all required adults were background cleared. LPA observed that hazardous items (disinfectants, cleaning solutions etc.) were inaccessible to children in care. Facility days and hours of operation are Monday-Friday from 2:00 PM to 6:00 PM except Wednesdays when school gets out early at 1:00 PM. The facility provides only afternoon snack. LPA conducted a file review prior to inspection and verified that annual fees were current. While on location, LPA reviewed care and supervision of children, staffing ratios, medications, first aid supplies, furniture, equipment, fire drills, and drinking water. LPA observed most required forms to be posted, and LPA provided S1 with the additional forms that need to be posted. There appear to be adequate toys and equipment available for children. LPA toured the outdoor play area, and S1 stated that toys and chalk are taken outside for play. S1 stated that drinking water is provided outside by a pitcher and cups. LPA reminded S1 that proper shade needs to be provided to the children in care when they are outside. LPA reviewed the sign in/out documents and observed that the children who were currently in care were properly signed-in. LPA reviewed children’s and staff files. LPA observed that the staff files were not complete and S1 was unable to produce proof of the required documentation in staff files. At least one staff member present today had current Pediatric CPR and First Aid (exp. 01/17/2024). Mandated Reporter Training is required; this training requirement may be met by using the Department’s Office of Child Abuse Prevention (OCAP) online training modules. The OCAP modules are free of cost and available at: http://www.mandatedreporterca.com/. The training is currently provided in English and Spanish. Report continues on 809-C

SUPERVISORS NAME: Jeanne Smith
LICENSING EVALUATOR NAME: Nola Maestas
LICENSING EVALUATOR SIGNATURE:	DATE: 03/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/16/2023

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, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833

FACILITY NAME: CHAMPIONS @ MARENGO RANCH ELEMENTARY	FACILITY NUMBER: 343603532
	VISIT DATE: 03/16/2023

NARRATIVE

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Incidental Medical Services (IMS) policy was discussed with S1 although no children currently enrolled require IMS. For IMS information, see PIN 22-02-CCP. 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.

S1 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.

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 to our main communication platform. To receive this important licensed related information, please 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 communications.

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/inspection-process.

In the areas that were evaluated today on 03/16/2023, one deficiency was cited on a subsequent 809-D page. LPA conducted an Exit Interview and the report was reviewed with S1. A Notice of Site visit was posted by LPA and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

SUPERVISORS NAME: Jeanne Smith
LICENSING EVALUATOR NAME: Nola Maestas
LICENSING EVALUATOR SIGNATURE:	DATE: 03/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/16/2023

LIC809 (FAS) - (06/04)

Page: 2 of 3

Document Has Been Signed on 03/29/2023 03:14 PM - It Cannot Be Edited

Created By: Nola Maestas On 03/16/2023 at 04:50 PM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833

FACILITY NAME: CHAMPIONS @ MARENGO RANCH ELEMENTARY	FACILITY NUMBER: 343603532
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/16/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101217

This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on LPA observation on 03/16/2023, the licensee did not comply with the section cited above when staff files were observed to be incomplete, and the Site Supervisor was unable to produce the required documentation for staff members which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 03/23/2023
	Plan of Correction
1 2 3 4	LPA will conduct a field visit to observe the staff files complete by 03/23/2023.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME:

Jeanne Smith

LICENSING EVALUATOR NAME:

Nola Maestas

LICENSING EVALUATOR SIGNATURE:

DATE: 03/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/16/2023

LIC809 (FAS) - (06/04)

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