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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434413753
Report Date: 06/25/2019
Date Signed: 06/25/2019 02:41:17 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 SCHOOLFACILITY NUMBER:
434413753
ADMINISTRATOR:MUNA KHANAFACILITY TYPE:
850
ADDRESS:5670 CAMDEN AVENUETELEPHONE:
(408) 390-3490
CITY:SAN JOSESTATE: CAZIP CODE:
95124
CAPACITY:60CENSUS: 2DATE:
06/25/2019
TYPE OF VISIT:Annual/RequiredUNANNOUNCEDTIME BEGAN:
01:05 PM
MET WITH:Muna KhanaTIME COMPLETED:
02:50 PM
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Licensing Program Analyst (LPA) Stephanie Rangel met with director/owner Muna Khanna for an annual required and case management - legal/Non-compliance inspection. LPA toured the Facility both inside and outside. LPA notes that there are two rooms in the preschool program: 3's and 4's rooms. LPA observed all the required posted materials including the facility license, Emergency Disaster Plan, Earthquake Preparedness Checklist, Notification of Parents' Rights, menu, Personal Rights and activity schedule.

LPA reviewed children's files and 2 staff files. At least one staff member present during the inspection has current CPR and First Aid certifications. LPA observed that the teacher/child ratio was in compliance during today's inspection. LPA reviewed the sign in and sign out sheets. Facility was in compliance with SB 792 (need for pertussis, measles, and/or declination of influenza vaccines from staff). Facility was in compliance with the requirement to complete Mandated Reporter Training for staff.

The rooms are clean. Staff and children's bathrooms are sanitary. Drinking water is readily available for the children indoor via water fountains and outside via personal water bottles. The center provides snacks. Cleaning supplies are kept in the Champion elementary school building. Janitorial service is provide weekdays in the evening.

The playground area utilized by children is surrounded by appropriate fencing and the outdoor surfaces are safe. Shade is provided by building overhang and trees. LPA observed that the outdoor equipment is age appropriate and in good condition. LPA observed wood chips as resilient material under the climbing structures. Owner stated that there are no weapons on the premises.

REPORT CONTINUED ON THE FOLLOWING PAGE (PAGE #2 - REPORT DATED 06/25/2019):
SUPERVISOR'S NAME: Anthony StudebakerTELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Stephanie C RangelTELEPHONE: (408) 334-8556
LICENSING EVALUATOR SIGNATURE:

DATE: 06/25/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/25/2019
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 SCHOOL
FACILITY NUMBER: 434413753
VISIT DATE: 06/25/2019
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CONTINUATION OF PREVIOUS PAGE (PAGE #1 - REPORT DATED 06/25/2019):

A review of staff records during today's inspection indicates that all Facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

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.

Periodic information releases accessible by signing up at: www.myccl.ca.gov.



Effect of Lead Exposure handout dated 1/20/19 given during today’s inspection. Per Assembly Bill (AB 2370), written information regarding lead exposure needs to be given out to enrolling and re-enrolling parents or guardians.

As a result of this inspection, no deficiencies were cited.

NOTICE OF SITE VISIT WAS ISSUED AND MUST REMAIN POSTED FOR 30 DAYS.
SUPERVISOR'S NAME: Anthony StudebakerTELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Stephanie C RangelTELEPHONE: (408) 334-8556
LICENSING EVALUATOR SIGNATURE:

DATE: 06/25/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/25/2019
LIC809 (FAS) - (06/04)
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