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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343603532
Report Date: 03/29/2023
Date Signed: 03/29/2023 03:29:54 PM

Document Has Been Signed on 03/29/2023 03:29 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
SACRAMENTO SOUTH, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
FACILITY NAME:CHAMPIONS @ MARENGO RANCH ELEMENTARYFACILITY NUMBER:
343603532
ADMINISTRATOR:MCNAIRN, JANETFACILITY TYPE:
840
ADDRESS:1000 ELK HILLS DR.TELEPHONE:
(916) 753-7001
CITY:GALTSTATE: CAZIP CODE:
95632
CAPACITY: 50TOTAL ENROLLED CHILDREN: 50CENSUS: 12DATE:
03/29/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Stacey WakefieldTIME COMPLETED:
04:00 PM
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On 03/29/2023, Licensing Program Analyst Katy Maestas (LPA) conducted a Case Management inspection to verify corrections of a deficiency cited on 03/16/2023. LPA arrived at the facility and was met by Site Supervisor Stacey Wakefield (S1). LPA disclosed the purpose of the inspection and was granted entrance into the facility. LPA toured the facility and observed 12 school aged children being supervised by L1 and 2 staff members. LPA determined, through accessing Guardian, that all required adults were background cleared.

On 03/16/2023, the facility was cited a Type B deficiency for incomplete staff files. LPA reviewed staff files on 03/29/2023 and assured that all employees have files that contain all documentation as required by Title 22. The deficiency that was cited on 03/16/2023 is cleared by today's field visit. A Proof of Correction letter was provided to S1.

No deficiencies were cited today in the areas that were evaluated. An exit interview was conducted, and the report was reviewed, with L1. Licensee Appeal Rights were provided by LPA. A Notice of Site visit was posted by LPA and must remain posted for 30 days. Failure to comply with posting requirements will result in an immediate civil penalty of $100.













SUPERVISORS NAME: Jeanne Smith
LICENSING EVALUATOR NAME: Nola Maestas
LICENSING EVALUATOR SIGNATURE: DATE: 03/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/29/2023
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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