343614708-8-16-2021-03-CC-JHOA-C5XPZF-20210816114529

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 343614708
Report Date: 08/16/2021
Date Signed: 08/16/2021 11:45:35 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 @ 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:	90	CENSUS: 17	DATE:	08/16/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Sandy Fultz		TIME COMPLETED:	12:00 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	On 08/16/2021, Licensing Program Analyst (LPA) Jan Hoshida conducted a random annual inspection. LPA met with Site Supervisor Sandy Fultz. The facility is located on Sunrise Elementary School grounds in Portables 1 and 2 (Classrooms #1, #2, #3 and #4). The school-age program is in Classroom #1, #3, and #4 from 6:30am to 6:00pm and in Classroom #2 from 12:45pm to 6:00pm. The facility operates Monday through Friday and is year-around. The facility provides morning and afternoon snacks for the children. Upon arrival, LPA observed 17 children supervised by two staff members. LPA toured the facility including all activity/classroom areas, the isolation area, food service area, restrooms, and outdoor play areas. LPA reviewed care and supervision of children, staffing ratios, health related services, furniture, equipment, drinking water, and food service provisions. The facility has a waiver to share the outdoor space with the elementary school and is used at alternate times than the school. Site Supervisor stated that the play structures and school bathrooms are not used and the children play on the grass, blacktop areas, and the shaded awning areas only. Site Supervisor stated that they also have a pop tent to provide shade when the children are outside to play. LPA reviewed the children's Identification and Emergency Information. LPA reviewed personnel's education and immunization requirements. All staff currently employed with the center have criminal record clearances and are associated to the Champions @ John Adams Elementary site facility #313621215 waiver on file and waiver is posted. At least one staff member present today has current EMSA approved Pediatric/Child CPR and First Aid. LPA discussed child care COVID-19 policies and procedures with Site Supervisor. LPA provided information for the on-line Guardian support information. *REPORT CONTINUED ON NEXT PAGE*

SUPERVISOR'S NAME: Maria Mayorga	TELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Jan Hoshida	TELEPHONE: (916) 917-6572
LICENSING EVALUATOR SIGNATURE:	DATE: 08/16/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2021

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

Page: 1 of 2

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: 08/16/2021

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
26
27
28
29
30
31
32

This facility provides Incidental Medical Services- IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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. LPA observed that all medication on site meet licensing requirements.

LPA discussed the Mandated Reporter Training with Site Supervisor. Beginning January 1, 2018, Health and Safety Code 1596.8662 requires all licensed providers, applicants, directors and employees to complete training as specified on their mandated reporter duties and to renew their training every two years. Volunteers are encouraged but not required to take the training. 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.

LPA checked facilities fees and confirmed that it is up to date.

LPA provided the Community Care Licensing’s website www.ccld.ca.gov, so the Site Supervisor can obtain updated licensing information, new regulations and access forms. LPA advised Site Supervisor of their responsibility to stay current in regards to new regulations. LPA also included the email address for the children's advocacy program to stay current on new laws childcareadvocatesprogram@dss.ca.gov.

No Title 22 Deficiencies observed in the areas that were evaluated. LPA reviewed report with the Site Supervisor and provided copies. An exit interview was conducted. LPA observed the Notice of Site Visit posted and the Site Supervisor understands it must remain posted for 30 days.

SUPERVISOR'S NAME: Maria Mayorga	TELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Jan Hoshida	TELEPHONE: (916) 917-6572
LICENSING EVALUATOR SIGNATURE:	DATE: 08/16/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2021

LIC809 (FAS) - (06/04)

Page: 2 of 2