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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004214
Report Date: 08/26/2020
Date Signed: 08/26/2020 11:43:29 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-HOOVER ELEMENTARYFACILITY NUMBER:
414004214
ADMINISTRATOR:PAYNE ALEX, TAMARAFACILITY TYPE:
840
ADDRESS:2220 SUMMIT DRIVETELEPHONE:
(650) 579-5664
CITY:BURLINGAMESTATE: CAZIP CODE:
94010
CAPACITY:56CENSUS: 10DATE:
08/26/2020
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Brennan BernardoTIME COMPLETED:
11:45 AM
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Due to the COVID-19 health crisis, and state, local county orders, a tele-inspection was conducted. Licensing Program Analyst (LPA) Van met with Area Manager, Brennan Bernardo, for case management via Facetime in conjunction with providing Technical Assistance guidelines during the COVID-19 pandemic. The Regional Office received an application from the facility requesting a capacity increase and room addition. The facility is operating in a functioning school site at Hoover Elementary School in Burlingame, serving school-age children, ages 5 - 12. The facility is currently licensed for a capacity of 56 in the library and classroom #1. The facility is requesting an increase of capacity from 56 children to 98 children and adding classroom #17, #18, and the multipurpose room. The facility has included a letter from the Chief Business Officer of Burlingame School District that permits the facility to use the mentioned rooms to be added to the license.

Mr. Bernardo leads LPA on a virtual inspection of the facility indoors for Health and Safety Hazards. Per the facility sketch that was submitted, and along with comment/recommendation from the Fire Inspector. The following is the measurement of the additional space.

· The multipurpose room measures 1839 sq ft (omitting the stage from the space) allows a maximum of 47 children.
· Room #17 measures 802 sq ft, subtract the encumbered space, allows for 15 children.
· Room #18 measures 552 sq ft, which allows for 15 children.
· The total number of children for the additional rooms is 77.

Continuation on the next page...
SUPERVISOR'S NAME: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Brendon VanTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 08/26/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2020
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-HOOVER ELEMENTARY
FACILITY NUMBER: 414004214
VISIT DATE: 08/26/2020
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All new rooms are clean, have adequate lighting, and ventilation. The new rooms do not have tables, chairs, or learning materials for the children at the time of this inspection. Mr. Bernardo states that teachers are working on moving all assets to the rooms and rearranging furniture in the coming days. Once complete, Mr. Bernardo states he will take pictures of the rooms and send them to LPA. LPA observed that each room is equipped with a centralized alarm system and a fire extinguisher. The facility has exclusive use of accessible boys' and girls' restrooms, maintained clean, in good repair, and have sufficient supplies.

Mr. Brennan was advised that a follow-up inspection will be conducted in the future, and the measurement of indoor and outdoor space may be required.

Fire clearance was granted on 08/18/20.

Prior to Licensure:

1) Submit LIC 500, and LIC 309
2) Qualification/Paperwork for new Director, Leila Rashid
3) Superintendent Certification.
4) All rooms need to have appropriate chairs, tables, learning materials for children.
5) Reviewed/Approved by Management, License will be updated for a capacity increase to 98 School-age children.
SUPERVISOR'S NAME: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Brendon VanTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 08/26/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2020
LIC809 (FAS) - (06/04)
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