343610212-8-28-2023-53-CC-JTES-CV5TC7-20230828143615

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 343610212
Report Date: 08/28/2023
Date Signed: 08/28/2023 02:36:21 PM

Document Has Been Signed on 08/28/2023 02:36 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 S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME:	CHAMPIONS @ ROY HERBURGER ELEMENTARY		FACILITY NUMBER:	343610212
ADMINISTRATOR:	TOTAH, MANUELA		FACILITY TYPE:	840
ADDRESS:	8670 MARANELLO DR.		TELEPHONE:	(916) 682-4788
CITY:	ELK GROVE	STATE: CA	ZIP CODE:	95624
CAPACITY:	75	CENSUS: 10	DATE:	08/28/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Manuela Totah		TIME COMPLETED:	02:45 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 (LPAs) Jennie Tedlos and Licensing Program Manager met with Director, Manuela Totah, for the purpose of an unannounced annual inspection. There were 10 children present at the time of the inspection. Facility days and hours of operation are Monday - Friday from 7:00 AM to 5:30 PM. LPA observed sign in/ out book and verified all children are properly signed in. This facility provides care to at least one military family. LPA toured the facility inside and out. LPA observed that hazardous items (disinfectants, cleaning solutions, etc.) were inaccessible to children in care. LPAs observed the following items during today's inspection: care and supervision of children, staffing ratios, first aid supplies, furniture, equipment, and access to drinking water. LPA observed all required forms to be posted. Outdoor play area was toured, the play structure appeared to be in good repair, and there is sufficient cushioning under the play structure, wood chips. Facility provides Breakfast and PM snack to children in care. All food is prepared on site. Kitchen was toured at the time of inspection. LPA reviewed children’s and staff files. LPA observed health screening reports with TB test and required MMR and TDAP vaccines. At least one staff member present today has current Pediatric CPR and First Aid. LPA observed AB1207 mandated reporter training certificates for all staff. The Director was reminded to renew the course every 2 years throughwww.mandatedreporterca.com website. The Director was reminded that all adults 18 and over, 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. *REPORT CONTINUED ON SUBSEQUENT PAGE, 809-C*

SUPERVISOR'S NAME: Bettina Engelman	TELEPHONE: (916) 215-3003
LICENSING EVALUATOR NAME: Jennie Tedlos	TELEPHONE: 916-263-5744
LICENSING EVALUATOR SIGNATURE:	DATE: 08/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2023

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
SACRAMENTO S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: CHAMPIONS @ ROY HERBURGER ELEMENTARY	FACILITY NUMBER: 343610212
	VISIT DATE: 08/28/2023

NARRATIVE

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Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. When any IMS is provided, an updated 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 are available at: https://www.ada.gov/resources/child-carecenters/.

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test. 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 verified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP

The Director was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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.

Exit interview conducted and report was reviewed with the Director. A notice of site visit was given and must remain posted for 30 days.

In the areas that were evaluated, no deficiencies were cited during the inspection.

SUPERVISOR'S NAME: Bettina Engelman	TELEPHONE: (916) 215-3003
LICENSING EVALUATOR NAME: Jennie Tedlos	TELEPHONE: 916-263-5744
LICENSING EVALUATOR SIGNATURE:	DATE: 08/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2023

LIC809 (FAS) - (06/04)

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