343614708-3-2-2020-03-CC-JHOA-BMBUF4-20200302143206

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 343614708
Report Date: 03/02/2020
Date Signed: 03/02/2020 02:32:11 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 @ SUNRISE ELEMENTARY		FACILITY NUMBER:	343614708
ADMINISTRATOR:	FULTZ, SANDY		FACILITY TYPE:	840
ADDRESS:	11821 COBBLE BROOK DRIVE		TELEPHONE:	(916) 294-0061
CITY:	RANCHO CORDOVA	STATE: CA	ZIP CODE:	95742
CAPACITY:	75	CENSUS: 17	DATE:	03/02/2020
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	01:05 PM
MET WITH:	Sandy Fultz		TIME COMPLETED:	02:50 PM

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On Monday, 3/2/20, at 1:05 p.m., Licensing Program Analyst (LPA), Jan Hoshida, conducted an unannounced Case Management inspection and met with Director, Sandy Fultz. The purpose of today’s inspection was to address Licensee’s request to increase the current school-age license capacity from 75 to 90 school-age children ages Kindergarten and up. At 1:10 p.m., LPA observed 17 school-age children supervised by two staff during this inspection. The facility has four classrooms (Classroom 1, 2, 3 and 4) within two portable buildings (Buildings 1 and 2) and is located on Sunrise Elementary School campus. The hours of operation are Monday through Friday from 6:30 a.m. to 6:00 p.m. The program follows the Elk Grove Unified School District calendar, runs before and after school programs during the school year and full day program during the summer and other days the elementary school is closed or off track.

Licensee requested within the change of capacity application to use Classrooms 1, 3 and 4 from 6:30 a.m. to 6:00 p.m. and Classroom 2 from 12:45 p.m. to 6:00 p.m. Director stated that Classroom 2 will be used by the preschool program from 6:30 a.m. to 12:45 p.m. Director stated that she understands that the preschool and school-age children may never commingle. The fire clearance was granted on 12/9/19.

The facility is located on a functioning public elementary school site therefore the classroom is exempt from square footage requirements. There are four restrooms located within the classrooms with a total of eight toilets and eight sinks. There are four additional sinks within the classrooms. Director stated that children are provided individual privacy when using the restroom and only one child is in the bathroom at a time. Director stated that staff utilize the staff bathroom within the elementary school campus.

The outdoor play area is fenced with a play ground and basketball courts. Director stated that she uses a pop-up tent to provide shade for the outside play area. There is a working drinking fountain. The facility is located on a functioning public elementary school site therefore the outside activity space is exempt from square footage requirements. Facility will also be sharing the outdoor activity space with the facility’s preschool program and the elementary school children.

REPORT CONTINUED ON NEXT PAGE

SUPERVISOR'S NAME: Bettina Engelman	TELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Jan Hoshida	TELEPHONE: (916) 917-6572
LICENSING EVALUATOR SIGNATURE:	DATE: 03/02/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/02/2020

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 @ SUNRISE ELEMENTARY	FACILITY NUMBER: 343614708
	VISIT DATE: 03/02/2020

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Director submitted an updated Application (LIC200A), Personnel Report (LIC 500) and facility sketches to LPA.

As of 3/2/20, Licensee’s request for a capacity increase of the license to serve 90 school-age children, from ages Kindergarten and above, will be granted. No deficiencies were cited during today’s inspection.

LPA reviewed this report with the Director. A Notice of Site Visit was provided and Director acknowledged that she understands that it remain posted for 30 days.

SUPERVISOR'S NAME: Bettina Engelman	TELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Jan Hoshida	TELEPHONE: (916) 917-6572
LICENSING EVALUATOR SIGNATURE:	DATE: 03/02/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/02/2020

LIC809 (FAS) - (06/04)

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