414001497-2-13-2020-05-CC-JSAI-BLRR9Z-20200213115022

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414001497
Report Date: 02/13/2020
Date Signed: 02/13/2020 11:50:30 AM

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 AT PORTOLA		FACILITY NUMBER:	414001497
ADMINISTRATOR:	HASAN, HIND		FACILITY TYPE:	840
ADDRESS:	300 AMADOR AVE., ROOM #1		TELEPHONE:	(650) 255-7457
CITY:	SAN BRUNO	STATE: CA	ZIP CODE:	94066
CAPACITY:	42	CENSUS: 0	DATE:	02/13/2020
TYPE OF VISIT:	Annual/Required	UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Hasan Hind		TIME COMPLETED:	12:00 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) Saini met with Director Hind Hasan for this required annual evaluation. The facility file was reviewed prior to this visit. A review of the personnel report on file indicates that all facility staff have received criminal record and child abuse index clearances. Purpose of the inspection was explained. At 8:30am, there were no children present as today is a minimum day. Program operates M-F, before- school 7:00-9:30am and after-school from 12:00-6:00PM, in Room #A on the Portola Elementary School site. Per Director, facility had 14 children present today in before school program. LPA observed that all children were sign in and sign out properly. At 8:45, LPA and the director inspected the facility for health and safety hazards. There are fully charged fire extinguishers that meet minimum requirements and 2 smoke detectors in the facility. Children's bathrooms inspected; The children's bathroom is clean and well maintained. No pools, spas, hot tubs, fish ponds, or similar bodies of water are present. Per Director, 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. The facility is maintained by a janitorial service. The outdoor area appears to be safe and all equipment appears to be in good condition. The facility provides snacks for children and the menu is posted for review. Medication is administered to children with parental written permission, is logged when given and is stored in a box in a locked cabinet in the classroom. There is a first aid kit that is stored in a cabinet in the classroom. Disaster drills are conducted every month and properly logged. Per Facility log, last fire drill was conducted on January 2020 at 1:10 PM. Five children’s records were reviewed at 9:30am, and contained signed admission agreements. All children files were complete and up-to the date. At 10:00 LPA reviewed Staff files. The director possessed current CPR and First Aid certifications, which expire 9/2021. Staff has completed Mandated Reporter training and certification is on the file.

SUPERVISOR'S NAME: Alma Malig	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Jyoti Saini	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 02/13/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2020

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 AT PORTOLA	FACILITY NUMBER: 414001497
	VISIT DATE: 02/13/2020

NARRATIVE

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Incidental Medical Services (IMS) policy was discussed. Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

During today's inspection the director confirmed that she receives email updates from the department.
No deficiencies were cited against the facility under CCR,Title 22, Div. 12, Chapt. 1.

>This report and rights to comment and appeal were discussed with Site Supervisor. This report must be available in the facility for public review. Notice of site inspection was posted.
Site Supervisor was advised any additional questions to call Office, M-F, 8am-5pm, 650-266-8800 or 1-844-538-8766. Website: www.ccld.ca.gov

SUPERVISOR'S NAME: Alma Malig	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Jyoti Saini	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 02/13/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2020

LIC809 (FAS) - (06/04)

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