414004214-9-24-2019-05-CC-MROZ-BGC2KM-20190924172811

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414004214
Report Date: 09/24/2019
Date Signed: 09/24/2019 05:28:29 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 ELEMENTARY		FACILITY NUMBER:	414004214
ADMINISTRATOR:	PAYNE-ALEX, TAMARA		FACILITY TYPE:	840
ADDRESS:	2220 SUMMIT DRIVE		TELEPHONE:	(408) 348-1610
CITY:	BURLINGAME	STATE: CA	ZIP CODE:	94010
CAPACITY:	56	CENSUS: 39	DATE:	09/24/2019
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Leila Rashid		TIME COMPLETED:	05:40 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) Marie Rodriguez made an unannounced 3 Year Annual Required inspection. LPA met with Site Director Leila Rashid and explained purpose of inspection. Care center is located in Room 1 and Library when needed inside Hoover Elementary School. Present in Room 1 were the Site Director, 1 teacher, and 27 school aged children. A teacher's aide arrived shortly after and went with the teacher to take the children to the playground. The Site Director picked up 12 more school aged children from Enrichment class and came back to room before also taking those children to the playground for outdoor play. Library was not in use at time of inspection. Center is operating within capacity limits and in compliance with staff to child ratio. Hours of operation are Monday to Friday before school from 7:00am to 8:30am and after school from 2:00pm to 6:00pm for children in Kindergarten and 3:00pm to 6:00pm for children from first to fifth grades. LPA inspected room with Site Director. There are no bodies of water, firearms, or weapons on the premises. The room is in good condition with proper temperature and ventilation and are free of any hazards. All furniture is in good repair. Rooms have age appropriate toys and equipment. Room has one bathroom with a toilet and a sink. Bathroom appears to be clean, in good repair, and free of any hazards. There is a separate bathroom on site for staff usage.The outdoor play area is fenced for supervision. The play structure is age appropriate and in good condition with sufficient cushioning underneath. All required postings are posted on the wall by the entrance of the room. Center only provides an afternoon snack. Drinking water is available for children indoor and outdoor. Food preparation area is clean and free of any toxins or contamination. All food is properly stored to avoid contamination. All storage containers for solid waste have a proper lid. All cleaning products, chemicals, and toxins are inaccessible to children. (Continued on second page)

SUPERVISOR'S NAME: Alma Malig	TELEPHONE: (650) -26-8800
LICENSING EVALUATOR NAME: Marie Rodriguez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 09/24/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2019

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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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-HOOVER ELEMENTARY	FACILITY NUMBER: 414004214
	VISIT DATE: 09/24/2019

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(Continued from first page)

Incidental Medical Services (IMS) was discussed with Site Director. There are no children receiving services during this school year. Last emergency drill was conducted on September 4, 2019. Emergency drills are conducted once a month and are properly logged. The center has a complete record of sign-in/out sheets by authorized pickup person. There are multiple first aid kits available. There is a working fire alarm system at the elementary. Room has a working smoke and carbon monoxide detector, a fully charged fire extinguisher, and a working telephone available.

Seven children records reviewed were complete. All children have a record of emergency identification information on file. Three staff records reviewed were complete. All staff have a criminal record clearance on file. Site Director has a current Pediatric First Aid/CPR certificate on file. All staff have taken Mandated Reporter training.

During inspection,
· Site Director was provided information regarding Incidental Medical Services (IMS). For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Section 101226. When any IMS is provided, a plan for providing IMS must be submitted to the Department.
· Site Director was reminded as of September 1, 2016, all Staff and Volunteers must provide proof of immunization against pertussis, measles, and influenza, or qualifies for an exemption, pursuant to Health and Safety code 1596.7995 and 1597.662.
· Site Director was reminded about Mandated Reporter Training available on CCLD website. Training must be completed every two years. (Websites: www.ccld.ca.gov or www.mandatedreporterca.com)
· Site Director was reminded about the Provider Information Notices (PINs) on CCLD website.

No deficiencies cited today.

This report was reviewed and discussed with Site Director Leila Rashid. A copy of report was provided. Notice of site visit was observed being posted and shall remain posted for 30 days.

Any additional questions, call CCLD Office, Monday - Friday, 8am - 5pm, (650) 266-8800 or 1 (844) 538-8766. Website: www.cdss.ca.gov.

SUPERVISOR'S NAME: Alma Malig	TELEPHONE: (650) -26-8800
LICENSING EVALUATOR NAME: Marie Rodriguez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 09/24/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2019

LIC809 (FAS) - (06/04)

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