343617619-8-22-2019-03-CC-LVIS-BFAPC6-20190822111126

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 343617619
Report Date: 09/14/2018
Date Signed: 08/22/2019 11:11:36 AM

COMPREHENSIVE INSPECTION

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME:	CHAMPIONS @ ARNOLD ADREANI ELEMENTARY		FACILITY NUMBER:	343617619
ADMINISTRATOR:	SHELLY DUNCAN		FACILITY TYPE:	850
ADDRESS:	9927 WILD HAWK WEST		TELEPHONE:	(916) 647-7269
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95829
CAPACITY:	39	CENSUS: 19	DATE:	09/14/2018
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	02:15 PM
MET WITH:	Ranndi Nasca		TIME COMPLETED:	03:30 PM

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LPAs LeGuie and Bello met with director Randi Nasca for the purpose of an annual random inspection. LPAs toured the building including all activity and classroom spaces, restrooms, food service and outdoor play areas. Appropriate ratio, care and supervision were observed during the visit. Designee was reminded never to exceed the conditions, limitations and capacity specified on the license.

Medications, toxic and hazardous items are appropriately stored and 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 materials to absorb the fall. Toileting facilities are in safe and sanitary condition. The food preparation space is free of litter. All food was protected against contamination. Trash cans containing solid waste had lids. Uncontaminated drinking water was readily available to children both indoors and outdoors. Menus were posted. Sign in and out sheets consisted of full legal signatures.

Incidental Medical Services (IMS) policy was discussed. 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 at: http://www.ada.gov/childqanda.htm.

A sample of staff and children's records were reviewed. At least one staff member present today has current Pediatric CPR and First Aid certification. A current roster and disaster drill log are being maintained. There are no firearms or bodies of water on the premises, and the facility has at least one functioning carbon monoxide detector. LPA reviewed the Departments inspection authority and discussed with designee any changes that may occur regarding the director or an employee acting in the director's absence must be reported to department within 10 working days.

SUPERVISOR'S NAME: Roxana Saravia	TELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Eunique LeGuie	TELEPHONE: (916) 491-0182
LICENSING EVALUATOR SIGNATURE:	DATE: 09/14/2018

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2018

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: 343617619
	VISIT DATE: 09/14/2018

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This facility evaluation report was reviewed and discussed with the director. 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 departments website at WWW.CCLD.CA.GOV for information regarding child care updates, forms, regulations and legislation pertaining child care centers.

In the areas that were evaluated, no deficiencies were observed at the time of the visit.

SUPERVISOR'S NAME: Roxana Saravia	TELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Eunique LeGuie	TELEPHONE: (916) 491-0182
LICENSING EVALUATOR SIGNATURE:	DATE: 09/14/2018

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2018

LIC809 (FAS) - (06/04)

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