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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434410632
Report Date: 08/26/2019
Date Signed: 08/26/2019 02:16:15 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:CHAMPION KINDER INTERNATIONAL SCHOOLFACILITY NUMBER:
434410632
ADMINISTRATOR:YANG, JANEFACILITY TYPE:
850
ADDRESS:1055 SUNNYVALE-SARATOGA ROADTELEPHONE:
(408) 838-3333
CITY:SUNNYVALESTATE: CAZIP CODE:
94087
CAPACITY:235CENSUS: 69DATE:
08/26/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
12:40 PM
MET WITH:Jane Yang & Jennifer LeeTIME COMPLETED:
02:40 PM
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LPA Oscar Huang met with Jane Yang, Licensee/Director, and Administrator, Jennifer Lee, for an unannounced annual/random inspection. LPA toured the facility indoor and outdoor. LPA observed the required posted materials, including the Facility License, Emergency Disaster Plan (LIC 610), Earthquake Preparedness Checklist (LIC 9148), Parents' Rights Poster (PUB 393), Personal Rights (LIC 613A), Child Car Seat Law (PUB 269), Menus (includes current and following week) and Activity Schedule. Also, the facility has and posts waiver on playgrounds usage. LPA observed 69 preschool children and 11 teachers.

A review of staff records on today indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. LPA reminded her of the applicable civil penalties for those adults who have not received fingerprint clearances, are not associated to the license and who come in contact with or provide care and supervision to the children. Penalty amounts: $100.00 per person per day, minimum of $100.00 to a maximum of $500.00 per person for an initial violation and a minimum of $100.00 to a maximum of $3000.00 per person for any subsequent violations within a 12-month period. Director understand upon notice of the Department to remove or to exclude an individual from the facility, she shall immediately remove the individual and prevent them from returning to the facility or having contact with children in care.

LPA reviewed 8 children and four staff files. Each child's file reviewed contains the Information and Emergency Information form (LIC 700), a copy of the admission agreement, Notification of Parent's Rights, and Personal Rights, and Physician Report. Immunization records were also updated. LPA observed that all children were properly signed in and out by a parent or authorized representative. All staff files reviewed contain the required transcripts/verification of experience. LPA observed at least one staff has current CPR and First Aid certifications on file. LPA observed that the teacher/child ratio was in compliance during today's visit. Director understands the conditions, limitations, and capacity specifications of the Facility license, and children shall be visually supervised at all times.

LPA observed that all preschool rooms are clean and safe for all children and staff. Drinking water is readily available for the children via school provided filtered water, and can be refilled both outdoor & indoor via children's own water bottles. LPA observed solid waste containers with tight-fitting lids in each room. Staff and children's bathrooms are clean, sanitary, and operable.


REPORT CONTINUED ON THE FOLLOWING PAGE (DATED 08/26/2019):
SUPERVISOR'S NAME: Sandy KnightTELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Yangcheng HuangTELEPHONE: 408-334-8321
LICENSING EVALUATOR SIGNATURE:

DATE: 08/26/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2019
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: CHAMPION KINDER INTERNATIONAL SCHOOL
FACILITY NUMBER: 434410632
VISIT DATE: 08/26/2019
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CONTINUATION OF PREVIOUS PAGE (PAGE #1 - REPORT DATED 08/26/2019):
There is a separate staff bathroom in the office not utilized by the children which an isolated child can use if needed. Director stated that there are no weapons or firearms on the premises. LPA observed sufficient mats for the children. Director stated that bed sheets are taking home washed every Friday.

The facility provides snacks and lunch to the children, lunch was prepared and delivered from outside vendor. All food is in kitchen and are current. The food preparation and storage areas are clean, free of litter & rubbish, and free of rodents and other vermin. All food and beverages that require refrigeration are stored in covered containers at 45 degrees F or less. 1% milk is provided. Cleaning supplies are inaccessible to the children and stored in locked kitchen cabinets inaccessible to children. Any medications at the facility are stored in the office. LPA observed all furniture and equipment are in good condition and safe for the children. The playground areas utilized by the preschool children is surrounded by appropriate fencing. LPA observed that the outdoor equipment is age appropriate and in good condition. LPA observed that there is sufficient rubber foam resilient materials around and under the play structures in the playgrounds, shade is provided by trees and building over hangs. LPA did not observe any bodies of water in the playground area.

LPA observed staff have all the immunization records in file per SB 792 Immunization Requirements. Incidental Medical Services (IMS) were discussed with Licensee/Director. Facility is not providing IMS at this time. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing 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.htmLicensee will submit a plan of operation for IMS if in the future they provide any IMS to a child in care.

LPA discussed Beginning January 1, 2018, Health and Safety Code 1596.8662 requires all licensed providers, applicants, directors and employees to complete training as specified on their mandated reporter duties and to renew their training every two years. The training web site is available at: http://www.mandatedreporterca.com LPA observed staff have completed their training.

No Deficiency is cited. Exit interview conducted with Administrator. A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE ENTRANCE TO THE HOME, AND MUST REMAIN POSTED FOR 30 DAYS.

SUPERVISOR'S NAME: Sandy KnightTELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Yangcheng HuangTELEPHONE: 408-334-8321
LICENSING EVALUATOR SIGNATURE:

DATE: 08/26/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2019
LIC809 (FAS) - (06/04)
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