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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434414659
Report Date: 09/08/2022
Date Signed: 09/08/2022 12:25:01 PM


Document Has Been Signed on 09/08/2022 12:25 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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131



FACILITY NAME:CHAMPIONS @ NODDIN ELEMENTARYFACILITY NUMBER:
434414659
ADMINISTRATOR:GLORIA LEWISFACILITY TYPE:
840
ADDRESS:1755 GILDA WAYTELEPHONE:
(408) 821-5015
CITY:SAN JOSESTATE: CAZIP CODE:
95124
CAPACITY:110CENSUS: 25DATE:
09/08/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:50 AM
MET WITH:Anjelica Del ToroTIME COMPLETED:
12:35 PM
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Licensing Program Analyst (LPA), James Santos conducted the Required 1 Year inspection today and met with staff, Bianca Madueno. Per staff, Director, Destiny Murillo is currently out of the office. There were other 4 staff present during today's inspection. LPA also spoke with Area Manager, Anjelica Del Toro on the phone. Angelica arrived at the center shortly thereafter.

LPA toured the indoor and outdoor areas with staff, Bianca. The required posted materials, including the Facility License, Emergency Disaster Plan (LIC 610), Parents' Rights Poster (PUB 393), Personal Rights (LIC 613A), Child Car Seat Law (PUB 269) and Activity Schedule are posted on the wall.

The classes are held in rooms 1, 2, 3 & 4. LPA observed the classrooms are clean and organized. All furniture and equipment are in good condition. There are age appropriate toys available for children. There are solid waste containers with tight-fitting lids in the classroom area. Staff and children's bathrooms were observed to be clean and sanitary. Drinking water is readily available indoor and outdoor for the children via water fountain and dispenser. The food preparation and storage area is clean, free of litter and rubbish. Cleaning supplies are locked in the closet room inaccessible to children. Fire extinguishers, fire alarm, smoke and carbon monoxide detectors and emergency first aid were observed in the classrooms. Per staff, there are no weapons or firearms on the premises.

The outside playground area is surrounded by appropriate fencing and was observed to be safe and free of hazards.

Due to time constraints, the annual inspection will be continued on a later date. Exit interview conducted and report was reviewed and a copy was provided with Area Manager.

NOTICE OF SITE VISIT WAS ISSUED AND MUST REMAIN POSTED FOR 30 DAYS.
SUPERVISOR'S NAME: Joel SeguraTELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: James G SantosTELEPHONE: (408) 334-8556
LICENSING EVALUATOR SIGNATURE:
DATE: 09/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/08/2022
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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