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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004214
Report Date: 08/22/2019
Date Signed: 08/22/2019 04:08:25 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-HOOVER ELEMENTARYFACILITY NUMBER:
414004214
ADMINISTRATOR:PAYNE-ALEX, TAMARAFACILITY TYPE:
840
ADDRESS:2220 SUMMIT DRIVETELEPHONE:
(408) 348-1610
CITY:BURLINGAMESTATE: CAZIP CODE:
94010
CAPACITY:28CENSUS: 0DATE:
08/22/2019
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
03:15 PM
MET WITH:Brennan BennardoTIME COMPLETED:
04:30 PM
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Licensing Program Analyst, LPA Yee conducted a case management inspection today. The facility requested to add a library and an increase in capacity. This is a combination center located at Hoover Elementary School. This classroom will be shared with the preschool program. Days and hours of operation are Monday - Friday. Preschool program operates from 8:30am - 2:00pm. School-age program operates from 7:00am - 8:30am, 2:00 - 6:00pm. The facility is previously licensed for 28 children in classroom #1. Superintendent letter is on file. However, fire Marshall is only approving for 28 capacity for the library. Today, LPA inspected the library for health and safety hazards. All furniture and equipment in the library appear to be safe and in good repair. LPA advised installing sensor alarm on the exit doors.

The additional capacity will be approved pending on fire clearance.
SUPERVISOR'S NAME: Alma MaligTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Jennifer YeeTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 08/22/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2019
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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