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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414000082
Report Date: 06/18/2024
Date Signed: 06/18/2024 05:02:50 PM

Document Has Been Signed on 06/18/2024 05:02 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:CHAMPIONS-LAS LOMITAS ELEMENTARY (SA)FACILITY NUMBER:
414000082
ADMINISTRATOR/
DIRECTOR:		PFEIFFER, SHARONFACILITY TYPE:
840
ADDRESS:299 ALAMEDA DE LAS PULGASTELEPHONE:
(650) 250-3658
CITY:ATHERTONSTATE: CAZIP CODE:
94027
CAPACITY: 276TOTAL ENROLLED CHILDREN: 113CENSUS: 38DATE:
06/18/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:55 PM
MET WITH:Director, Sharon PfeifferTIME VISIT/
INSPECTION COMPLETED:
04:00 PM
NARRATIVE
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On June 18th, 2024 at approximately 12:55PM, Licensing Program Analyst (LPA) Tapia-Mandujano conducted an unannounced, annual, required inspection. LPA met with Director, Sharon Pfeiffer and explained the purpose of the inspection. Present in the facility are Director and Site Supervisor and 14 staff supervising 38 school-age children. All adults working in the facility are fingerprint cleared and associated.

Program operates on Las Lomitas Elementary School. Facility is licensed to operate in all the school classrooms. At this moment facility is operating Summer Program in Rooms 606 and 607. The hours of operation are Monday- Friday 7:30am-6pm. During the school year facility will operate Monday-Friday from 7am-8am and 1:30pm-6pm.

LPA observed classrooms to be clean and equipped with age appropriate toys and materials. Storage for children's belongings are located inside the classrooms, labeled with each child's individual names. LPA observed facility has an installation of a fire alarm system inside each classroom as well as a fully charged, fire extinguishers located inside the classrooms. The classrooms have a smoke and carbon monoxide detector installed as well as emergency kits with first aid materials, as well as keeping emergency contact information in the office. Per Director, there are currently children with prescribed medication. Facility has a plan in place to properly store Medication, inaccessible to enrolled children and will be maintained with proper documentation in each child's file.

All poisons, cleaning solutions and hazardous materials are stored inaccessible to children in off limit areas or facility high shelves. Facility has parents provide lunch and facility will provide all the snacks. Water is available to children indoors and outdoors.


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SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Leslit Tapia-Mandujano
LICENSING EVALUATOR SIGNATURE: DATE: 06/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/18/2024
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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: CHAMPIONS-LAS LOMITAS ELEMENTARY (SA)
FACILITY NUMBER: 414000082
VISIT DATE: 06/18/2024
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Outdoor area appears to be clean and orderly. There are a variety of outdoor equipment that are in good working condition. Children are signed in and out of facility. Facility has license documentation and information properly posted and available for review in Room 606. There are no pools or bodies of water on the promises. Per Director, children will occasionally have water play with supervision and the water is emptied out after each use.

LPA reviewed facility records that included 7 children's records and 5 staff records. LPA observed children's records to be complete. Files that were reviewed showed that all staff have an up to date CPR & First Aid certificate. As well as all staff have up to date Mandated Reporter Certificate. Last emergency drill was conducted 05/2024. Emergency drills are conducted at least once every six months and are properly logged and documented.

Facility representative was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

Facility was informed that as of September 1, 2016, a person may not be employed or volunteer at a child care facility unless he or she has been immunized against influenza, pertussis, and measles or qualifies for an exemption pursuant to Health and Safety code 1596.7995 and 1597.662.

Director is aware that all staff is required to complete Mandated Reporter Training every two years. The training can be obtained online at www.mandatedreporterca.com. LPA observed the completion certificate on file. LPA encourages the director to frequently visit our website at www.ccld.ca.gov for licensing regulations and new updates.


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SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Leslit Tapia-Mandujano
LICENSING EVALUATOR SIGNATURE:

DATE: 06/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2024
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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: CHAMPIONS-LAS LOMITAS ELEMENTARY (SA)
FACILITY NUMBER: 414000082
VISIT DATE: 06/18/2024
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This facility provides Incidental Medical Services – IMS. Facility must submit and IMS plan to the department. LPA reviewed storage of “medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see PIN 22-02-CCP. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514-0383 (TTY) and link to publication. Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/.

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test.

For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1-CCP).

Facility tested rooms that were previously used for school age program. Facility has not been tested for the rooms that are currently being used, deficiency was issued. Refer to LIC 809D for more details.

Facility representative was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

Based on today's inspection, deficiencies were observed, according to California Title 22, Health and Safety Code of Regulations.

A notice of site visit was given and must remain posted for 30 days.



Exit interview conducted and report was reviewed with Director, Shanon Pfeiffer.
SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Leslit Tapia-Mandujano
LICENSING EVALUATOR SIGNATURE:

DATE: 06/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 06/18/2024 05:02 PM - It Cannot Be Edited


Created By: Leslit Tapia-Mandujano On 06/18/2024 at 03:51 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: CHAMPIONS-LAS LOMITAS ELEMENTARY (SA)
FACILITY NUMBER: 414000082

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/18/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
WD
101700(b)
Written Directives for Lead Testing
(b) All licensed Child Care Centers operating in buildings constructed before January 1, 2010, shall test their water for lead pursuant to these written directives.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on iinterview and record review, the licensee did not comply with the section cited above as the facility did not test all the rooms required by the deadline January 1, 2010 pursuant to the written directives which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/18/2024
Plan of Correction
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Facility will test the appropriate faucets for drinking and/or prepping water in classrooms that will be occupied or have an approved attestation by the department for exemption of lead testing.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Marie Rodriguez
LICENSING EVALUATOR NAME:Leslit Tapia-Mandujano
LICENSING EVALUATOR SIGNATURE:
DATE: 06/18/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/18/2024


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