343611164-8-22-2019-03-CC-MLOR-BFASJP-20190822135527

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 343611164
Report Date: 08/22/2019
Date Signed: 08/22/2019 01:55:40 PM

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 @ ARNOLD ADREANI ELEMENTARY		FACILITY NUMBER:	343611164
ADMINISTRATOR:	MENDEZ, ESTHER		FACILITY TYPE:	840
ADDRESS:	9927 WILDHAWK WEST DRIVE		TELEPHONE:	(916) 405-6094
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95829
CAPACITY:	75	CENSUS: 18	DATE:	08/22/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	10:50 AM
MET WITH:	Randi Nasca		TIME COMPLETED:	02:10 PM

NARRATIVE

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Licensing Program Analysts (LPAs) Mai Lor and Kelly Ferrara met with Program Director Randi Nasca for the purpose of an unannounced annual random inspection. The Director was reminded never to exceed the conditions, limitations, and capacity specified on the license. Census included 18 school-age children supervised by two staff. The school age license operates in portable classroom #1 and #2 before and after care. The program utilizes the multipurpose room and classroom C7 on the school campus as needed.

LPAs toured all activity and classroom spaces, restrooms, food service, and outdoor play areas. Medications are stored appropriately and are inaccessible to children. Toxic and hazardous items are inaccessible to children. Furniture and equipment are in good condition. Playground equipment and surfaces are free of loose or sharp parts. The areas around or under climbing equipment are cushioned with bark to absorb the fall. Toileting facilities are in safe, sanitary, and operating condition. The floors appeared clean throughout the facility. The food preparation space is free of litter and all food was protected against contamination. Storage containers with solid waste have tight-fitting covers. The program provides afternoon snacks. Menus were posted and drinking water was readily available to children both indoors and outdoors. LPAs observed full legal signatures while reviewing the sign-in and sign-out sheet as required for school-age component.

A random sample of staff and children's files were reviewed. Each child's file contained an emergency card and a consent for medical treatment. At least one staff member present today has current Pediatric CPR and First Aid certification (exp. 06/2021). A current fire drill log was observed with the last one conducted on July 2019.

Report continues on 809-C.

SUPERVISOR'S NAME: Roxana Saravia	TELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Mai Lor	TELEPHONE: (916) 491-0182
LICENSING EVALUATOR SIGNATURE:	DATE: 08/22/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2019

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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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 @ ARNOLD ADREANI ELEMENTARY	FACILITY NUMBER: 343611164
	VISIT DATE: 08/22/2019

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LPAs observed a functional carbon monoxide detector. LPAs reviewed the Department's inspection authority and discussed with Director any changes that may occur regarding the director or an employee acting in the Director's absence must be reported to department within ten working days.

Incidental Medical Services (IMS) policy was discussed. IMS is provided by this facility. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. 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)/(800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available athttp://www.ada.gov/childqanda.htm.

This facility evaluation report was reviewed and discussed with Program Developer. A Notice of Site Visit was provided and should remain posted for a period of 30 days for parental review. Director was encouraged to the visit the department's website at WWW.CCLD.CA.GOV for information regarding child care updates, forms, regulations and legislation pertaining child care centers. LPA provided and discussed Effects of Lead Exposure brochure.

In the areas that were evaluated, no deficiencies observed during this inspection. An exit interview was conducted and report was reviewed with licensee who stated she understands todays inspection. Notice of Site Visit posted and licensee understands it must remain posted for 30 days.

SUPERVISOR'S NAME: Roxana Saravia	TELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Mai Lor	TELEPHONE: (916) 491-0182
LICENSING EVALUATOR SIGNATURE:	DATE: 08/22/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2019

LIC809 (FAS) - (06/04)

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