414000082-7-20-2021-05-CC-GASL-C54UU6-20210720155257

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414000082
Report Date: 07/20/2021
Date Signed: 07/20/2021 03:53:12 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME:	CHAMPIONS-LAS LOMITAS ELEMENTARY (SA)		FACILITY NUMBER:	414000082
ADMINISTRATOR:	PFEIFFER, SHARON		FACILITY TYPE:	840
ADDRESS:	299 ALAMEDA DE LAS PULGAS		TELEPHONE:	(650) 250-3658
CITY:	ATHERTON	STATE: CA	ZIP CODE:	94027
CAPACITY:	120	CENSUS: 19	DATE:	07/20/2021
TYPE OF VISIT:	Case Management - Other	UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Sharon Pfeiffer		TIME COMPLETED:	02:30 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 (LPA) Glenn Schnell met with Director Sharon Pfeiffer today for a case management inspection in response to a request to increase the capacity of the school age program from 120 to 176 children ages 5-12. The facility is locate and at Las Lomitas Elementary School campus. This program will operate Monday - Friday; 6:30 AM to 6:00 PM. The facility was inspected today, indoor and outdoor, for health and safety hazards and measured to calculate capacity. Since the school age program is operated on a functioning elementary school site, the rooms can be used as elementary school classrooms, and the rooms will be leased by KCE Champions, the program is exempt from certain indoor/outdoor square footage requirements, fencing requirements, toilet/sink ratios, isolation requirements and indoor square footage requirements. The school age children will have use of the elementary school playgrounds and outside bathrooms which provide individual privacy. Staff will escort children to and from the bathrooms located on the campus of the elementary school and will ensure the bathrooms are clean and safe prior to being used by any children. Indoor: Rooms to be used will be: 3,37,39, 9 and 10, 1A , 1 and 2. Rooms 3 and 37 will be used as additional indoor space and will not be used when in use by the preschool program. Rooms 9 and 10 will not be used when in use by the preschool program. The additional rooms being requested for use are rooms 1 and 2. The Licensee has obtained a capacity letter from the school principal that confirms the maximum capacity of children for each room to be used (28 children in room 1, 28 children in room 2, total 56). The indoor space for children is observed today to be clean and all furnishing, toys and equipment observed to be safe and in good condition. There is storage space for children's personal belongings.

SUPERVISOR'S NAME: Ali Zebila	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Glenn A Schnell	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 07/20/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2021

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, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: CHAMPIONS-LAS LOMITAS ELEMENTARY (SA)	FACILITY NUMBER: 414000082
	VISIT DATE: 07/20/2021

NARRATIVE

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The indoor spaces are equipped with a fire extinguisher, smoke and carbon monoxide detectors, garbage cans with tight-fitting lids, first aid and emergency supplies. Rooms 3 and 37 have food prep areas with refrigerators. Rooms 1 and 2 each have 2 sinks one toilet. The bathrooms provide for individual privacy.
Sign-in/Sign out of the children will be documented by electronic signature. Bathrooms were observed to be clean and with no health and safety hazards. Bathrooms are located on the school campus outside of the proposed rooms to be used. The sinks accessible to children do not deliver water warmer than 120 degrees. The program will provide access to water via commercial water dispensers and cups for indoor. All toxins and other hazardous items will be stored in a locked cabinet or container in the classroom and will be inaccessible to children. Isolation of ill children will be located in the school office.
Outdoor: The outdoor area is the elementary school playground. The playground was observed to be clean, safe and equipped with toys and equipment for children. Since the outdoor space is used for elementary school children as well as children that will be in this licensed after school care program, the applicant will ensure close supervision of the children and ensure there is not commingling of children from the elementary school and community in general, and the children participating in this after school care program. Pitchers of water and cups will be used for drinking water outside. Shade for children is provided by shade structures.

SUPERVISOR'S NAME: Ali Zebila	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Glenn A Schnell	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 07/20/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2021

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, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: CHAMPIONS-LAS LOMITAS ELEMENTARY (SA)	FACILITY NUMBER: 414000082
	VISIT DATE: 07/20/2021

NARRATIVE

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The following items were reviewed as part of today's visit: Record keeping for staff, children and facility records, Care and Supervision of the Children, Child Discipline Procedures, Emergency Evacuation Procedures, Medication Policies, Isolation of Sick Children, Food Service, Transportation-none provided, Parents Rights, and Reporting Requirements. LPA Schnell observed all required postings.
The facility will conduct monthly disaster drills and a log will be maintained for review upon request. The applicant has a copy of the elementary school fire clearance which was completed on June 18, 2021. This will be accepted since the rooms used are located on a functioning elementary school site and the rooms, when not in use by this program, can be used as classrooms for instruction to students who attend Las Lomitas Elementary School.
This facility provides Incidental Medical Services – IMS. Storage and administration for IMS was discussed.
A license for an increase in capacity will be recommended once the following is received:
-A room capacity letter from the Elementary School principal indicating the rooms to be used by KCE and the capacity for each one; room 3 is not included on the current letter.

An electronic copy of this report and the Notice of Site Visit is being emailed to the director, Sharon Pfeiffer, at SPfeiffer@discoverchampions.com and Area Manager Brennan Bennardo at Bbennardo@discoverchampions.com by close of business day on 7/20/21.

SUPERVISOR'S NAME: Ali Zebila	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Glenn A Schnell	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 07/20/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2021

LIC809 (FAS) - (06/04)

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