414004214-1-17-2025-05-CC-MZAA-DCZVRC-20250117153943

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414004214
Report Date: 01/17/2025
Date Signed: 01/17/2025 03:39:55 PM

Document Has Been Signed on 01/17/2025 03:39 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 CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME:	CHAMPIONS-HOOVER ELEMENTARY		FACILITY NUMBER:	414004214
ADMINISTRATOR/ DIRECTOR:	ROMERO, VANESSA		FACILITY TYPE:	840
ADDRESS:	2220 SUMMIT DRIVE		TELEPHONE:	(650) 619-0436
CITY:	BURLINGAME	STATE: CA	ZIP CODE:	94010
CAPACITY: 98	TOTAL ENROLLED CHILDREN: 98	CENSUS: 0	DATE:	01/17/2025
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	12:50 PM
MET WITH:	Director, Vannessa Romero		TIME VISIT/ INSPECTION COMPLETED:	03:55 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 January 17, 2025, at approximately 1:00 PM, Licensing Program Analyst (LPA) Melissa Zaragoza conducted an unannounced, annual inspection. LPA met with the director, Vanessa Romero, and explained the purpose of the visit. Champions Hoover is a school age program. School age program is located inside the building of Champions Hoover School. School age program has 5 rooms licensed, rooms, 1, 17, 18, the library, and multi- purpose room. Program currently operates in room 1 only, and sometimes the library. Hours of operation are Monday through Friday 7:00am to 9:00am, and 3:00pm to 6:30pm. On Tuesdays, facility operates from 2:00pm to 6:30pm. Present during LPA's visit was the director, 3 staff members, and 0 children. Per director, children haven’t arrived. School age program is operating within capacity limits and ratio during LPA's visit. LPA inspected facility, indoors and outdoors, for health and safety hazards. Classroom includes a variety of equipment and materials that were in good condition. LPA observed classroom to have age-appropriate furniture, equipment, and materials. LPA observed no cleaning materials or poisonous items accessible to children in care, in classroom. Per director, children to do not sleep while they are in the program. Children bring their water bottles from home and can refill their water bottles at the refill stations, located around the school campus. Classroom is equipped with a fully charged fire extinguisher and first aid kits. LPA observed Carbon monoxide detector in the classroom. Carbon monoxide detector was tested during visit and were observed to be working. LPA was unable to test smoke alarm. Smoke alarm is located in classroom’s high ceilings and is wired with the entire school building. Storage for children's belongings is inside the classroom. (Continue Report on Page 2...)

Marie Rodriguez	TELEPHONE: (650) 266-8827
Melissa Zaragoza	TELEPHONE: 650-266-8800
	DATE: 01/17/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/17/2025

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 CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: CHAMPIONS-HOOVER ELEMENTARY	FACILITY NUMBER: 414004214
	VISIT DATE: 01/17/2025

NARRATIVE

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There is one-bathroom children can use. The bathroom is located inside the classroom. Bathroom was observed to have 1 sink and 1 toilet. Bathroom for children were observed to be clean. The sink and toilet were in working condition. LPA observed no cleaning solutions, poisons, and other hazardous materials for to be accessible to children in the bathroom.

Program provides a food service of snack only. Per director, children eat inside the class or outside in the outdoors seating area. Outdoor area was observed to have benches for children to sit and eat. There is a trash can bin for children to throw away their food once they are done eating.

Facility has two outdoor space areas. Outdoor space areas are entirely enclosed and fenced. LPA observed the outdoor play area for the younger children to have be fully fenced, with fake grass flooring, and a play structure. LPA observed the older children’s play area to have cement flooring, a play structure, and a basketball court. LPA observed many outdoor materials for children to play with. LPA observed toys and material to be in good condition.

Program uses a sheet to sign in and out for their sign in/sign out system. Children were properly signed in during LPAs’ visit. LPA observed licensing posters and required documents to be properly collected. Program’s last disaster drills was conducted on October 16, 2024.

LPA reviewed 7 facility staff records. LPA reviewed 6 random children facility records which were complete and had all required documents. Children's records have emergency information on file. Staff on site have a current CPR/First Aid certification. Director was reminded Mandated Reporter training must be renewed every 2 years by all staff working with children. Staff records also include required immunizations that were made available for review.

Director was reminded all staff hired are required to complete Mandated Reporter Training every two years. The training can be obtained online at www.mandatedreporterca.com.

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process

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SUPERVISOR'S NAME: Marie Rodriguez	TELEPHONE: (650) 266-8827
LICENSING EVALUATOR NAME: Melissa Zaragoza	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 01/17/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/17/2025

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 CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: CHAMPIONS-HOOVER ELEMENTARY	FACILITY NUMBER: 414004214
	VISIT DATE: 01/17/2025

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Director was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test.

Per director, building was constructed after 2010. During visit director provided LPA with proof.

LPA's discussed the safe sleep regulations with director and discussed the Child Care Licensing Safe Sleep webpage athttps://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep as an additional resource. LPA also informed director of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see PIN 22-02-CCP. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514-0383 (TTY) and link to publication. Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/.

Director was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

No deficiencies were cited today.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the director, Vanessa Romero.

SUPERVISOR'S NAME: Marie Rodriguez	TELEPHONE: (650) 266-8827
LICENSING EVALUATOR NAME: Melissa Zaragoza	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 01/17/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/17/2025

LIC809 (FAS) - (06/04)

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