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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414000476
Report Date: 09/26/2019
Date Signed: 09/26/2019 04:04:04 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-SANDPIPER ELEMENTARYFACILITY NUMBER:
414000476
ADMINISTRATOR:MCLAUGHLIN, MICHELEFACILITY TYPE:
840
ADDRESS:797 REDWOOD SHORES PARKWAYTELEPHONE:
(650) 780-7322
CITY:REDWOOD CITYSTATE: CAZIP CODE:
94065
CAPACITY:75CENSUS: 60DATE:
09/26/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:Michele Mclaughlin TIME COMPLETED:
04:30 PM
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Licence Program Analyst (LPAs) Kaur and Singh met with Director, Michele Mclaughlin, for case management inspection of an incident. Purpose of inspection was explained. Director self reported the incident on September 11, 2019. Facility reported a grandmother of the child asked information about the time when the father of the child observed a teacher grabbed the child with arm during the pick up time.

During today's inspection, LPAs interviewed the director. The director stated that director talked with the father over the phone and father informed that he observed a teacher has hand on child's shoulder and not letting go the shoulder. Per director, the father of the child was not upset or concerned. Director sated that director also talked with the mother of the child over the phone. Director conducted the teacher's interviews and provided the copy of information received to the department. Per director, child is still in facility and grandmother pick up child everyday.

No violation of any regulation was observed. Copy of this report is reviewed and provided to the director. Notice of site visit is posted and shall remain posted for next 30 days..
SUPERVISOR'S NAME: Ali ZebilaTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Harsimran KaurTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 09/26/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2019
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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