<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414001443
Report Date: 08/26/2020
Date Signed: 08/26/2020 04:32:32 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-LINCOLN ELEMENTARY (SA)FACILITY NUMBER:
414001443
ADMINISTRATOR:JONES, ADELINEFACILITY TYPE:
840
ADDRESS:1801 DEVEREUX DRIVETELEPHONE:
(650) 697-7400
CITY:BURLINGAMESTATE: CAZIP CODE:
94010
CAPACITY:75CENSUS: 22DATE:
08/26/2020
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Brennan BernardoTIME COMPLETED:
04:45 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
Due to the COVID-19 health crisis, and state, local county orders, a tele-inspection was conducted. Licensing Program Analyst (LPA) Van met with Area Manager, Brennan Bernardo, for case management via Facetime in conjunction with providing Technical Assistance guidelines during the COVID-19 pandemic. The Regional Office received an application from the facility requesting a capacity increase and room addition. The facility is operating in a functioning school site at Lincoln Elementary School in Burlingame, serving school-age children, ages 4.9 - 12. The facility is currently licensed for a capacity of 75 in the library and the portable room #15. The facility is requesting an increase of capacity from 75 children to 131 children and adding room #8, room #14, and the multipurpose room. The facility has included a letter from the Chief Business Officer of Burlingame School District that permits the facility to use the mentioned rooms to be added to the license.

Mr. Bernardo leads LPA on a virtual inspection of the facility indoors for Health and Safety Hazards. Per the facility sketch that was submitted, along with comment/recommendation and approved fire clearance from the Fire Inspector. The following is the square footage and children allow for each room.

· The multipurpose room measures 3068 sq ft (omitting the stage from the space) allows for 87 children.
· Room #8 measures 786 sq ft, subtract the encumbered space, allows for 20 children.
· Room #14 measures 786 sq ft, which allows for 22 children.
· The total number of children for the additional rooms is 129.

Continuation on the next page...
SUPERVISOR'S NAME: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Brendon VanTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 08/26/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2020
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, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: CHAMPIONS-LINCOLN ELEMENTARY (SA)
FACILITY NUMBER: 414001443
VISIT DATE: 08/26/2020
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
All new rooms are clean, have adequate lighting, and ventilation. The new rooms do not have tables, chairs, or learning materials for the children at the time of this inspection. Mr. Bernardo states that teachers are working on moving all assets to the rooms and rearranging furniture in the coming days. Once complete, Mr. Bernardo states he will take pictures of the rooms and send them to LPA. LPA observed that each room is equipped with a centralized alarm system and a fire extinguisher. The facility has exclusive use of accessible boys' and girls' restrooms, maintained clean, in good repair, and have sufficient supplies. Drinking water is available to children through water fountains. There are individualized cubbies available for each child.

During the inspection, LPA provided Technical Assistance for Covid-19 guidelines. Mr. Brennan was advised that a follow-up inspection will be conducted in the future, and the measurement of indoor and outdoor space may be required.

Fire clearance was granted on 08/18/20.

Prior to Licensure:

1) Submit LIC 500, and LIC 309
2) Superintendent Certification.
3) All rooms need to have appropriate chairs, tables, learning materials for children.
4) Reviewed/Approved by Management, License will be updated for a capacity increase to 131 School-age children.
SUPERVISOR'S NAME: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Brendon VanTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 08/26/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2020
LIC809 (FAS) - (06/04)
Page: 2 of 2