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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343611165
Report Date: 09/29/2021
Date Signed: 09/29/2021 12:08:08 PM

Document Has Been Signed on 09/29/2021 12:08 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, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
FACILITY NAME:CHAMPIONS @ HELEN CARR CASTELLO ELEMENTARYFACILITY NUMBER:
343611165
ADMINISTRATOR:CHARMAINE BALAOROFACILITY TYPE:
840
ADDRESS:9850 FIRE POPPY DRIVETELEPHONE:
(916) 690-8718
CITY:ELK GROVESTATE: CAZIP CODE:
95757
CAPACITY: 100TOTAL ENROLLED CHILDREN: 0CENSUS: 10DATE:
09/29/2021
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Charmaine BalaoroTIME COMPLETED:
12:30 PM
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On Wednesday September 29, 2021, at 9:00AM Licensing Program Analyst (LPA) Fabiola Diaz met with Facility Representative Charmaine Balaoro for an unannounced annual random inspection for the School Age Program. Upon arrival, LPA observed 9 children supervised by two staff, and a 10th child arrived during the inspection. Facility operates Monday through Friday from 6:30AM to 6:00PM in three portable classrooms. Facility Representative stated that although the license also includes the Multipurpose Room, it is usually not used by the children. Facility Representative explained that in her time at the facility, the facility has never had the full capacity of 100 at one time. Facility Representative was reminded never to exceed the conditions, limitations and capacity specified on the license.

LPA toured all activity and classroom spaces, restrooms, and outdoor play areas. Medications were stored appropriately at the facility. Toxic and hazardous items are inaccessible to children. Furniture and equipment are in good condition. Playground equipment and surfaces are free of loose or sharp parts. Toileting facilities are in safe, sanitary, and operating condition. The floors appeared clean throughout the facility. The food preparation space is free of litter and all food was protected against contamination. Storage containers with solid waste have tight-fitting covers. Facility provides afternoon snacks, which is delivered by US Foods. Menus are posted and drinking water is readily available to children both indoors and outdoors. Facility Representative stated that during COVID-19 children are bringing their own water bottles, which are refilled at the facility any time needed and the facility also has extra water bottles. LPA observed sign-in and sign-out sheets with legal signatures.

SUPERVISORS NAME: Jeanne Smith
LICENSING EVALUATOR NAME: Fabiola Diaz
LICENSING EVALUATOR SIGNATURE: DATE: 09/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/29/2021
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
FACILITY NAME: CHAMPIONS @ HELEN CARR CASTELLO ELEMENTARY
FACILITY NUMBER: 343611165
VISIT DATE: 09/29/2021
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Two staff and 10 children’s records were reviewed. Each child's file contained an emergency card and files were complete. At least one staff member present today has current Pediatric CPR and First Aid certification. All staff currently employed with the facility have a criminal record clearance, health screening report, mandated reporter certificates, and documentation of the educational background, training, and/or experience. There are no firearms, poisons, or bodies of water on the premises. LPA observed a functional carbon monoxide detector. LPA reviewed the Department's inspection authority and discussed with Facility Representative 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.

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226.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

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

Facility Representative was reminded that all adults 18 and over, 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 Child Care Center. 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.

In the areas that were evaluated, no deficiencies were cited on today’s date. Exit interview was conducted and report was reviewed with Facility Representative. A Notice of Site Visit was provided and should remain posted for a period of 30 days.

SUPERVISORS NAME: Jeanne Smith
LICENSING EVALUATOR NAME: Fabiola Diaz
LICENSING EVALUATOR SIGNATURE:

DATE: 09/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2021
LIC809 (FAS) - (06/04)
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