414004219-6-15-2022-05-CC-BVAN-CFEQKZ-20220615121510

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414004219
Report Date: 06/15/2022
Date Signed: 06/15/2022 12:16:03 PM

Document Has Been Signed on 06/15/2022 12:16 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
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME:	CHAMPIONS - FRANKLIN ELEMENTARY		FACILITY NUMBER:	414004219
ADMINISTRATOR:	GIACOMINO, KAYLA		FACILITY TYPE:	840
ADDRESS:	2385 TROUSDALE DRIVE		TELEPHONE:	(650) 867-6046
CITY:	BURLINGAME	STATE: CA	ZIP CODE:	94010
CAPACITY:	219	CENSUS: 5	DATE:	06/15/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:35 AM
MET WITH:	Thomas Malave		TIME COMPLETED:	12:30 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 June 15, 2022, Program Analyst (LPA) Van performed an unannounced mandated annual inspection and met with the new Director, Thomas Malave. Mr. Malave has submitted all required Director's qualifications to the Department, except for the three units of the Administration course. The Department has granted a Director exception letter that allowed Mr. Malave to act as a Director until he completes the Admin course and submits it to the Department. The purpose of the inspection was explained to the Director. This facility is a school-aged after-school program that operates in the Franklin Elementary School in Burlingame. The school approved the Center to use classrooms #10, #17, #18, #19, #20, #21, #22, portable #23, #24, the library, computer lab, and the multipurpose room. Classrooms #10, #17, #18, #19, #21, #22, the library, computer lab, and the multipurpose room were not used today. The days and hours of operations are Monday to Friday, the morning program from 7:00 am to 8:40 am the after-school program from 3:00 pm to 6:00 pm. Per Director, today is the last day of the school year. However, the facility is open for the summer session that started on June 20 until August 19. In the morning today, five children were being supervised by the Director. The Director and LPA inspected the facility for potential health and safety hazards. LPA observed the facility had signed in and out records with complete parents' signatures, and all signatures matched the number of children in care. All classrooms have age-appropriate games, books, and equipment in good repair. Classrooms have acceptable ventilation and ample lighting. LPA observed each child has their cubbies with their name labeled. The facility has a centralized smoke detector, a fully charged fire extinguisher, and carbon monoxide. There are no pools, spas, or other bodies of water at the facility. All cleaning solutions, poisons, and other dangerous chemicals are stored in the cabinet underneath the sink with a child-proof lock. LPA observed the unused electrical outlets have covers and installed. All the bathrooms, toilets, and sinks are clean and well sanitized. All solid waste bins have a suitable tight-fitted lid on top. The facility has multiple water dispensaries and water fountains by the sinks that are readily available for children. The food preparation area is clean and sanitary. The outdoor playground area is in good repair and completely fenced for supervision. The play structure is age-appropriate and in good condition, with tan bark cushioning underneath for any accidental fall.

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Brendon Van	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 06/15/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/15/2022

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 - FRANKLIN ELEMENTARY	FACILITY NUMBER: 414004219
	VISIT DATE: 06/15/2022

NARRATIVE

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In today's inspection, LPA reviewed random samples of children's and Director's records. Per Director, a designated teacher will pick up the Pre-k, TK, and first graders in their classrooms and bring them to the program. The older children will walk to the program by themselves. The teacher will sign in all children, and a head count will be conducted before entering the classroom. All children had a medical assessment, and required licensing forms were completed. Staff has criminal record clearance. Director has a record of valid Pediatric FirstAid/CPR cards in the file and the required immunization. LPA also observed that the facility had posted the required forms. (i.e., License, waivers, Notification of Parent's Rights, and Notification of Personal Rights). The Director stated that Fire and Earthquake drills are done every month, and the last drills were conducted on 5/3/2022.
The incidental Medical Services (IMS) policy was discussed. For IMS information, see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm
The Director was reminded that all adults 18 and over, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.
LPA reminded the Director that as of September 1, 2016. A person may not be employed or volunteer at a childcare facility unless he or she has been immunized against influenza, pertussis, and measles. LPA observed that the facility has a record of required immunization of all staff.
The Director was informed about Mandated Reporter training available on the CCLD website. In addition to AB1207 Training required to complete every two years by all staff hired, a one-time General Training is also required. Training can be taken online at www.mandaterreporterca.com. Also, the Director was reminded of Pesticides training. Information on the DPR website at: www.cdpr.ca.gov/shoolipm/childcare

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Brendon Van	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 06/15/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/15/2022

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 - FRANKLIN ELEMENTARY	FACILITY NUMBER: 414004219
	VISIT DATE: 06/15/2022

NARRATIVE

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LPA encouraged the Director to visit the CCLD website at www.ccld.ca.gov for licensing regulations and new updates. The Director can also email at childcareadvocatesprogram@dss.ca.gov and ask for the updates to be added to the email list.
To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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/process.

During the inspection, LPA requested the following document to be sent to the Licensing office by June 30:
1. Designation of Responsibility (LIC 308)
2. Incidental Medical Services (IMS) Plan
3. Completion of the Administration course (Official transcript)

No deficiencies were cited today. An exit interview was conducted, and the report was reviewed with the Director, Thomas Malave. Today's report, June 15, 2022, and notice of site visit will be sent to the Director by email by the close of business on June 15, 2022. Confirmation of receipt is required. LPA informed the Director that the site visit notice must be posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Brendon Van	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 06/15/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/15/2022

LIC809 (FAS) - (06/04)

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