343611165-2-15-2023-53-CC-CBEY-CP426X-20230215160752

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 343611165
Report Date: 02/15/2023
Date Signed: 02/15/2023 04:08:01 PM

Document Has Been Signed on 02/15/2023 04:08 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
SACRAMENTO SOUTH, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833

FACILITY NAME:	CHAMPIONS @ HELEN CARR CASTELLO ELEMENTARY		FACILITY NUMBER:	343611165
ADMINISTRATOR:	CHARMAINE BALAORO		FACILITY TYPE:	840
ADDRESS:	9850 FIRE POPPY DRIVE		TELEPHONE:	(916) 690-8718
CITY:	ELK GROVE	STATE: CA	ZIP CODE:	95757
CAPACITY: 100	TOTAL ENROLLED CHILDREN: 100	CENSUS: 13	DATE:	02/15/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Charmaine Balaoro		TIME COMPLETED:	04:15 PM

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On Wednesday, February 15, 2023 @ 1:05 pm, Licensing Program Analyst’s (LPA’s) Corina Beckby and Stacey Williams met with Site Director (SD), Charmaine Balaoro for an unannounced annual random inspection for the School Age Program. Facility operates Monday through Friday from 6:30AM to 6:00PM & 7:30 AM- 5:30 PM during Summer and Spring Break, in three portable classrooms. SD stated that although the license also includes the Multipurpose Room, it has never been used by the children.

Upon arrival, LPA observed 13 children supervised by two staff during the inspection. SD was reminded never to exceed the conditions, limitations and capacity specified on the license.

LPA’s observed the following items during today's inspection: care and supervision of children, staffing ratios, first aid supplies, furniture, equipment, and access to drinking water. LPA’s observed all required forms to be posted.

Facility uses the main school's outdoor play area, located behind the multipurpose room. SD stated the program only uses the black top closest to the entry of the program building and do not use the playground structure located on the opposite side of the premises. This outdoor play area is age appropriate for 5-12 years of age and was toured. The play structure appeared to be in good repair, and there is sufficient cushioning (bark) under the play structure LPA’s reviewed the sign in/out book and observed that the children are properly signed in/out.

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SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Corina Beckby
LICENSING EVALUATOR SIGNATURE:	DATE: 02/15/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/15/2023

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833

FACILITY NAME: CHAMPIONS @ HELEN CARR CASTELLO ELEMENTARY	FACILITY NUMBER: 343611165
	VISIT DATE: 02/15/2023

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Three staff and six children’s records were reviewed. Each child's file contained an emergency card and files were complete. All staff employed have a criminal record clearance, health screening report, mandated reporter certificates, and documentation of the educational background, training, and/or experience. LPA’s observed health screening reports with TB test and required MMR and TDAP vaccines. At least one staff member present today has current Pediatric CPR and First Aid (exp. 08/2023). LPA’s observed AB1207 Mandated Reporter training certificates for all staff. The Director was reminded to renew the course every 2 years through www.mandatedreporterca.com website.

There are no firearms, poisons, or bodies of water on the premises. LPA’s observed a functional carbon monoxide detector. LPA’s reviewed the Department's inspection authority and discussed with SD 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.

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 morning and afternoon snacks, which is delivered by US Foods Market. Menus are posted. Children bring personal water bottles and can refill as needed at drinking faucet and is readily available to children both indoors and outdoors.

This facility provides Incidental Medical Services – IMS. LPA’s 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.

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SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Corina Beckby
LICENSING EVALUATOR SIGNATURE:	DATE: 02/15/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/15/2023

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 SOUTH, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833

FACILITY NAME: CHAMPIONS @ HELEN CARR CASTELLO ELEMENTARY	FACILITY NUMBER: 343611165
	VISIT DATE: 02/15/2023

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SD 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 SD. A Notice of Site Visit was provided and should remain posted for a period of 30 days Failure to comply with posting requirements shall result in an immediate civil penalty of $1.

SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Corina Beckby
LICENSING EVALUATOR SIGNATURE:	DATE: 02/15/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/15/2023

LIC809 (FAS) - (06/04)

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