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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004219
Report Date: 02/22/2023
Date Signed: 02/22/2023 04:36:59 PM

Document Has Been Signed on 02/22/2023 04:36 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 CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:CHAMPIONS - FRANKLIN ELEMENTARYFACILITY NUMBER:
414004219
ADMINISTRATOR:MALAVE, THOMASFACILITY TYPE:
840
ADDRESS:2385 TROUSDALE DRIVETELEPHONE:
(650) 867-6046
CITY:BURLINGAMESTATE: CAZIP CODE:
94010
CAPACITY: 219TOTAL ENROLLED CHILDREN: 219CENSUS: 12DATE:
02/22/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:35 PM
MET WITH:Thomas MalaveTIME COMPLETED:
04:50 PM
NARRATIVE
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Licensing Program Analyst (LPA) Andrea Medlin met with facility representative for this case management visit due to an incident that happened on 2/8/2023. Purpose of the visit explained. There are 12 children present during the visit. Only the administrator is present initially. Initially, there are no other staff present during visit thereby preventing administrator/director from performing administrative functions including assisting licensing during the visit. Later another staff person arrived to assist.

On 2/8/2023, a former staff person (S1) exposed a child in the program to inappropriate content and violated facilities own policy as well as the personal rights of child in incident.

The deficiencies cited on the following page are in violation of the California Code of Regulations, Title 22, Division 12, Chapter 1:

This report is reviewed with facility representative, Thomas Malave, and a copy of this report must be made available for public review upon request.
SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Andrea Medlin
LICENSING EVALUATOR SIGNATURE: DATE: 02/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/22/2023
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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Document Has Been Signed on 02/22/2023 04:36 PM - It Cannot Be Edited


Created By: Andrea Medlin On 02/22/2023 at 03:13 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: CHAMPIONS - FRANKLIN ELEMENTARY
FACILITY NUMBER: 414004219

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/22/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/15/2023
Section Cited
CCR
101215.1(c)

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The child care center director shall be responsible for the operation of the center, for compliance with regulations, and for communications with the Department. This requirement is not met as evidence there is only the director here acting in a teacher role.
(continued below)
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Facility to come up with a plan to have the director able to fullfill administrative functions, assist licensing during visits, and not be in ratio when needed for administrator duties.

Proof of correction shall be sent to the licensing office by 3/15/2023.
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The only staff person here is the director and is in ratio watching 12 children. The director is unable to fulfill administrative functions nor initially assist licensing as there are no other staff present. This poses a potential health and safety hazard.
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Type B
03/15/2023
Section Cited
CCR101223(a)(1)

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The licensee shall ensure that each child is accorded the following personal rights:
To be accorded dignity in his/her personal relationships with staff and other persons.This requirement is not met based on evidence that a former staff person gave a personal electronic device to a child in care which contained explicit and inappropriate images.
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Facility has terminated the involved staff person and a staff meeting was held with Chamions staff as a reminder of the policy on personal electronic devices not being shared with children.
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The police department and school district condcuted their own investigation. Subsequently, the staff person involved admitted it was an accident and that staff person was terminated. This poses a potential health and safety hazard to children in care.
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Facility to send a copy of staff person's termination letter and a copy of the staff meeting agenda that addresed this topic.

Send a copy to the licensing office by 3/15/2023.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Daniel J Oquendo
LICENSING EVALUATOR NAME:Andrea Medlin
LICENSING EVALUATOR SIGNATURE:
DATE: 02/22/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/22/2023


LIC809 (FAS) - (06/04)
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