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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004219
Report Date: 08/12/2019
Date Signed: 08/12/2019 01:32:42 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 - FRANKLIN ELEMENTARYFACILITY NUMBER:
414004219
ADMINISTRATOR:TABORA, JOANNE, DIRFACILITY TYPE:
840
ADDRESS:2385 TROUSDALE DRIVETELEPHONE:
(650) 867-6046
CITY:BURLINGAMESTATE: CAZIP CODE:
94010
CAPACITY:90CENSUS: 42DATE:
08/12/2019
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Brennan BennardoTIME COMPLETED:
01:45 PM
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Licensing Program Analyst, LPA Yee conducted a case management inspection today. There are 42 children and 6 staff members present. The facility requested to add classrooms #10 and #20 and an increase in capacity. The facility is previously licensed for 90 children in classrooms #19, #23, #24. This is a school-age program located at Franklin Elementary school. Superintendent letter is on file for the additional 47 children. Days and hours of operation: Monday - Friday, 7:00 am to 6:00 pm. Today, LPA inspected classrooms #10 and #20 for health and safety hazards. All furniture and equipment in both classrooms appear to be safe and in good repair. Fire clearance approval for the additional 47 children is on file.

LPA will recommend an additional 47 children in classrooms #10. and #20.
SUPERVISOR'S NAME: Alma MaligTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Jennifer YeeTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 08/12/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2019
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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