344501253-9-23-2024-53-CC-ASIS-D9DNNL-20240923103656

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 344501253
Report Date: 09/23/2024
Date Signed: 09/23/2024 12:15:44 PM

Document Has Been Signed on 09/23/2024 12:15 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 S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME:	CHAMPIONS @ JAMES MCKEE		FACILITY NUMBER:	344501253
ADMINISTRATOR/ DIRECTOR:	JACKSON, LYSANDREA		FACILITY TYPE:	860
ADDRESS:	8701 HALVERSON DR		TELEPHONE:	(916) 714-1195
CITY:	ELK GROVE	STATE: CA	ZIP CODE:	95624
CAPACITY: 45	TOTAL ENROLLED CHILDREN: 45	CENSUS: 0	DATE:	09/23/2024
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:00 AM
MET WITH:	Sandi Jackson		TIME VISIT/ INSPECTION COMPLETED:	11:00 AM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Centralized Application Bureau (CAB) Licensing Program Analyst (LPA) Alecia Sifuentes and Licensing Program Analyst (LPA) Jennie Tedlos met with Site Director Sandi (Lysandrea) Jackson for the purpose of a pre-licensing inspection. Licensee requests a preschool component for 24 children from three years to entry into kindergarten and a school-age component for 21 children enrolled in kindergarten and above for a total capacity of 45. The fire clearance (STD850) was granted and received on 9/13/2024. LPA informed the Site Director that the facility will be converted to a single child care center license under facility number 344501253, therefore LPA will be closing the current school-age facility number 343604602. The facility is located at James McKee Elementary School. The program currently operates Monday through Friday from 7:00 a.m. to 5:30 p.m. The facility will provide morning and afternoon snack and parents will provided lunches. LPA reviewed with the Site Director the LIC 311A, Records To Be Maintained At The Facility, for child’s records, personnel records, administrative records, and documents to be posted. INDOOR ACTIVITY SPACE: There is one preschool classroom located in Room #2 and one school-age classroom located in Room #1. LPA observed a sufficient amount of equipment, toys, tables, chairs, cubbies, and napping cots. There is a first aid kit located in each classroom. Medications will be stored in the locker near the Site Director's office area. LPA observed cleaning disinfectants are appropriately stored and inaccessible to children. Site Director stated there are no poisons or firearms on the premises. Water pitchers and cups will be used for the children indoors and outdoors. LPA observed a functional carbon monoxide detector in each classroom. LPA observed an electronic sign-in/sign-out binder. Report continues on LIC809-C page 2.

SUPERVISORS NAME: Mai Lor
LICENSING EVALUATOR NAME: Alecia Sifuentes
LICENSING EVALUATOR SIGNATURE:	DATE: 09/23/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2024

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: CHAMPIONS @ JAMES MCKEE	FACILITY NUMBER: 344501253
	VISIT DATE: 09/23/2024

NARRATIVE

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Per Health and Safety Code 1596.806, the school-age component is exempt from square footage requirements; therefore, LPA did not take measurements of the school-age classroom. LPA measured the preschool classroom (Room #2). The preschool classroom contains a total of 864 square feet, which will accommodate Licensee’s request for 24 preschool children. There is one toilet and one sink located in the school-age classroom and one toilet and one sink located in the preschool classroom. Licensee has requested a Shared Bathroom Waiver for the preschool children to utilize the school-age bathroom, when needed. The school-age children will also use the elementary school restrooms. There is a separate private restroom for the staff located in the front office and outside across from the preschool portable. Children who become ill during the day will be isolated in the Site Director office area and will use the staff restroom, if necessary.

OUTDOOR ACTIVITY SPACE:
There are three outdoor activity spaces on the property, Preschool Yard (front grass area), Preschool Playground and School-age Playground. The outdoor play areas are fenced with a chain link fence that is at least four feet tall. LPA observed a sufficient amount of equipment and toys. LPA observed a play structure located on the preschool playground. LPA observed a label on the play structure designated for ages 2-5 years old. Site Director informed LPA that the preschool playground is also utilized by another child care facility #343616384. Site Director has requested a Shared Outdoor Space Waiver between the two programs. There are no bodies of water on the premises. There are shaded areas supplied by trees, canopy, and overhangs.

Per Health and Safety Code 1596.806, the school-age component is exempt from square footage requirements; therefore, LPA did not take measurements of the school-age playground. LPA measured the preschool outdoor activity spaces. The preschool outdoor activity areas contain a total of 8,246 square feet, which will accommodate Licensee’s request for 24 preschool children.

This facility plans to provide Incidental Medical Services – IMS. For IMS information, see PIN 22-02-CCP. A 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) or (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

Report continues on LIC809-C page 3.

SUPERVISORS NAME: Mai Lor
LICENSING EVALUATOR NAME: Alecia Sifuentes
LICENSING EVALUATOR SIGNATURE:	DATE: 09/23/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2024

LIC809 (FAS) - (06/04)

Page: 2 of 3

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: CHAMPIONS @ JAMES MCKEE	FACILITY NUMBER: 344501253
	VISIT DATE: 09/23/2024

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LPA discussed the following: 100% supervision is required at all times, including in the bathroom; personal rights; inspection authority; reporting requirements; staff to children ratios and capacity; staff qualifications; and maintaining buildings and grounds. LPA discussed with the Site Director any changes that may occur regarding the director or an employee acting in the director's absence must be reported to department within 10 working days.

Site Director was reminded that all adults 18 and over responsible for administration or direct supervision of staff, persons who provides care and supervision to children, and staff who have contact with children, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day for a maximum of 5-days or, if the penalty is for a repeat violation, for a maximum of 30-days per person will be assessed if this regulation is violated.

Site Director was informed of the MyChildCarePlan.org site, a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform. To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

Exit interview conducted and report was reviewed with the Site Director Sandi Jackson.

The following items are required before a license will be issued:

1. Pending waiver request reviews from Regional Manager (RM) Roxana Saravia.

SUPERVISORS NAME: Mai Lor
LICENSING EVALUATOR NAME: Alecia Sifuentes
LICENSING EVALUATOR SIGNATURE:	DATE: 09/23/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2024

LIC809 (FAS) - (06/04)

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