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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434410632
Report Date: 11/16/2021
Date Signed: 11/16/2021 03:17:45 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: 23DATE:
11/16/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Jane YangTIME COMPLETED:
04:00 PM
NARRATIVE
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Licensing Program Analyst (LPA) Oscar Huang met with Licensee/Director, Jane Yang for an unannounced annual inspection. LPA explained the nature of today’s inspection to Licensee. LPA also observed 5 staff and 23 preschool day care children in the facility during today's inspection. Days and hours of operation are Monday to Friday, 9:00am to 5:50pm.

Licensee/Director, Jane Yang was reminded that all adults 18 and over living or working in the facility, 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 licensed Family Child Care Home. 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.

Incidental Medical Services (IMS) policy was discussed. Office Manager, Jennifer Lee stated that the facility has a IMS plan, but currently there is no children required IMS services. 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

A notice of site visit was given and must remain posted for 30 days.
Exit interview conducted and report was reviewed with the Office Manager, Jennifer Lee.
SUPERVISOR'S NAME: Sandy KnightTELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Yangcheng HuangTELEPHONE: 408-334-8321
LICENSING EVALUATOR SIGNATURE:

DATE: 11/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2021
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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