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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414001443
Report Date: 08/02/2023
Date Signed: 08/02/2023 04:59:33 PM


Document Has Been Signed on 08/02/2023 04:59 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 CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066



FACILITY NAME:CHAMPIONS-LINCOLN ELEMENTARY (SA)FACILITY NUMBER:
414001443
ADMINISTRATOR:KAYLA GENOCHIOFACILITY TYPE:
840
ADDRESS:1801 DEVEREUX DRIVETELEPHONE:
(650) 697-7400
CITY:BURLINGAMESTATE: CAZIP CODE:
94010
CAPACITY:131CENSUS: 0DATE:
08/02/2023
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME BEGAN:
02:10 PM
MET WITH:Kayla GenochioTIME COMPLETED:
04:45 PM
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Licensing Program Analyst (LPA) Andrea Medlin met with facility representative for this case management visit due to a request for room changes. Facility is licensed to serve school aged children on the Lincoln Elementary School campus and currently operates the school age program in portables #8, #14, #15, library, and multipurpose room. Facility is no longer going to use portable #8 and requests to license/add portable #13. No change of capacity will result in this room change. Burlingame Fire Department has approved the fire clearance on 6/22/2023. Days and hours of operation for the school aged program vary based on dismissal times: Monday-Friday 7:00AM-6:30PM. Since this is a functioning school site, facility is exempt from the following: indoor square footage, fencing, and toilets. Physical plant toured, including the areas used for the program, and outdoor play areas to inspect for health and safety hazards. There are fully charged fire extinguishers that meet minimum requirements, smoke detectors, and carbon monoxide (CO) detectors present in each portable. Children's bathrooms inspected; all toilets and hand washing facilities are in safe and sanitary operating condition. A separate staff bathroom is available. No pools, spas, hot tubs, fish ponds, or similar bodies of water are present. Per staff, there are no firearms or weapons on site. Disinfectants, cleaning solutions, poisons and other items that are dangerous to children are inaccessible. Variety of age appropriate toys and materials for children are available in the facility. Facility provides snacks. First aid supplies are available. There are school aged outdoor play areas. The areas around and under high climbing equipment is cushioned with soft rubber. Outdoor activity space surfaces are free of hazards. Facility has posted all the required licensing forms. This facility meets the licensing requirements to operate in addition to already licensed areas and add portable #13 and new areas used are recommended and approved as of today, 8/2/2023. New license shall be posted when received.

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SUPERVISOR'S NAME: Daniel J OquendoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Andrea MedlinTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 08/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/02/2023
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 CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: CHAMPIONS-LINCOLN ELEMENTARY (SA)
FACILITY NUMBER: 414001443
VISIT DATE: 08/02/2023
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This report is reviewed with facility representative and a copy of this report must made be available for public review upon request.

No Notice of Site visit given as this was a scheduled visit due to facility non-operational status on summer break.
SUPERVISOR'S NAME: Daniel J OquendoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Andrea MedlinTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 08/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/02/2023
LIC809 (FAS) - (06/04)
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