414001497-4-4-2023-05-CC-CQUO-CQKT4U-20230404142429

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414001497
Report Date: 04/04/2023
Date Signed: 04/04/2023 02:24:35 PM

Document Has Been Signed on 04/04/2023 02:24 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 AT PORTOLA		FACILITY NUMBER:	414001497
ADMINISTRATOR:	HASAN, HIND		FACILITY TYPE:	840
ADDRESS:	300 AMADOR AVE., ROOM #1		TELEPHONE:	(650) 440-1371
CITY:	SAN BRUNO	STATE: CA	ZIP CODE:	94066
CAPACITY:	42	CENSUS: 8	DATE:	04/04/2023
TYPE OF VISIT:	Case Management - Other	UNANNOUNCED	TIME BEGAN:	01:35 PM
MET WITH:	Hind Hassan		TIME COMPLETED:	03:00 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	On April 4, 2023 at approximately 1:35pm, Licensing Program Analyst (LPA) Catrina Quimbo conducted an unannounced, case management inspection. LPA met with director, Hind Hassan, and explained the purpose of the inspection. Present during LPA's visit included director, 1 staff member and 8 school age children. Champions program is an after school program that operates at Portola Elementary School. Champions program at Portola Elementary is currently licensed for 42 school age children and is licensed to operate in Classroom #77 only. Director requested to add Classroom #75 for school age children TK to 5th grade. Capacity will remain as 42 school age children. Hours of operation are Monday through Friday 7:00am to 8:00am and 1:00pm to 6:00pm. LPA was provided copy of school district fire inspection conducted 07/2021. The school age program is exempt from requirements for indoors and outdoor space square footage, fencing and toilet/sink ratios. No measurements were taken during LPA's visit. Classroom #75 was inspected, indoors and outdoors, for health and safety hazards. Main entrance to Classroom #75 is through side gate, through outdoor area, located on left side of Classroom #78. LPA observed Classroom to be clean, equipped with age appropriate materials and furniture that were in good working condition. Storage for children's belongings are located inside the classroom. Classroom is equipped with a working carbon monoxide detector, first aid kit, fire extinguisher and a fire alarm system that is installed by school district. Classroom is equipped with a working phone on site. LPA observed poisons, cleaning solutions and hazardous materials to be stored inaccessible to children in classroom's high shelves. LPA observed licensing documentation to be properly posted and available for review. There are two separate restrooms (boys and girls) that are located outside the classroom, in the multi-purpose area. Champions program is not licensed to utilize multi-purpose area and will continue to be a pass by area only. Director is aware children must always be supervised coming to and from restrooms. (Continue Report on Page 2...)

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Catrina Quimbo	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 04/04/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/04/2023

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 AT PORTOLA	FACILITY NUMBER: 414001497
	VISIT DATE: 04/04/2023

NARRATIVE

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LPA observed bathrooms to be in proper working condition. Restrooms allow for individual privacy.

A second outdoor area for Champions use is located directly outside Classroom #75. Outdoor area is entirely enclosed with an at least 5 ft. high fence. LPA did not observe any pools, spas or bodies of water in outdoor area. There is a shed in outdoor area that will be used to store Champions' outdoor materials.

Water is made available to children both indoors and outdoors through children's individual water bottles. Children are able to refill their water bottles through filtered water stations in classroom. Garbage bin in classroom was observed to have a tight fitting lid. Per director, garbage bins are disposed of daily by school district's janitorial services.

Director was reminded that all adults, 18 and over, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

Champions program will be licensed to utilize Classrooms #75, #77, playground #1 (outside Classroom #75), and playground #2 (outside Classroom #77) for 42 school age children.

Director is aware an updated fire clearance report must be provided to department.

Notice of Site Visit was given. Director is aware Notice of Site Visit must be posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with director, Hind Hassan.

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Catrina Quimbo	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 04/04/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/04/2023

LIC809 (FAS) - (06/04)

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