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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343608259
Report Date: 05/30/2019
Date Signed: 05/30/2019 11:50:57 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
FACILITY NAME:CHAMPIONS @ IRENE WEST ELEMENTARYFACILITY NUMBER:
343608259
ADMINISTRATOR:STEWART, ANNAFACILITY TYPE:
840
ADDRESS:8625 SERIO WAYTELEPHONE:
(916) 681-5244
CITY:ELK GROVESTATE: CAZIP CODE:
95758
CAPACITY:50CENSUS: 8DATE:
05/30/2019
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Amy Dodge and Leah CromwellTIME COMPLETED:
12:00 PM
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Licensing Program Analysts (LPAs) Kelly Ferrara and Amie Randa met with Area Manager Amy Dodge and Director Leah Cromwell for purpose of an unannounced case management inspection. An application was received for a request to decrease capacity from 50 school age children to 32 school age children. The census upon arrival was 8 school age children. All adults present have obtained a finger print clearance with the department.

The facility was originally licensed in two portables room #1 and room #2 with a school age square footage exemption; under Health and Safety Code Section 1596.806. LPAs observed that room #2 will now be designated for school age children and room #1 is pending a preschool license; therefore the school age program will only operate out of room #2. Room #2 was measured and the square footage does not accommodate the requested capacity of 32 children. The Area Manager needs to obtain a request from the school superintendent in order for the facility to meet the guidelines for the school age square footage exemption Health and Safety Code.

LPAs observed drinking fountains inside the classroom and children have individual water bottles for outside play. The bathroom is located inside the classroom and LPAs observed two toilets and two sinks. LPAs observed a fire extinguisher and functioning smoke and carbon monoxide detector. LPAs observed sign in/out sheets, menus, and licensing documents were all posted for parental review. There is ample outdoor space to accommodate the requested capacity and the Director stated that children utilize the school playground and field with track for outdoor play. LPAs advised that they need to request a waiver for shared playground space.

LPAs reviewed the report with the Area Manager and Director and provided Notice of Site. LPAs recommend the decrease in capacity to 32 children, pending a letter from the school superintendent for use of the multi-purpose room. No deficiencies cited based on today's inspection.
SUPERVISOR'S NAME: Bettina EngelmanTELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Kelly FerraraTELEPHONE: (916) 425-5935
LICENSING EVALUATOR SIGNATURE:

DATE: 05/30/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/30/2019
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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