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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343611165
Report Date: 02/15/2023
Date Signed: 03/02/2023 11:11:16 AM

Document Has Been Signed on 03/02/2023 11:11 AM - 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 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: 100CENSUS: DATE:
02/15/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Charmaine BalaoroTIME COMPLETED:
01:00 PM
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THIS IS AN AMENDED REPORT OF REPORT ORIGINALLY WRITTEN ON FEBRUARY 15, 2023.

Licensing Program Analysts (LPA's) Corina Beckby and Stacey Williams met with Site Director (SD) Charmaine Balaoro for the purpose of conducting an unannounced case management visit to follow up on an Unusual Incident Report that was submitted on February 13, 2023. LPA's observed thirteen (13) children supervised by two staff. Criminal record clearances have been verified.

LPA’s conducted interviews.

No Title 22 deficiencies were observed or were cited on today’s date. Exit interview was conducted, and report was reviewed with Director. 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 $100.

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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