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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343611165
Report Date: 11/29/2023
Date Signed: 11/29/2023 10:33:40 AM

Document Has Been Signed on 11/29/2023 10:33 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 S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
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: 60CENSUS: 2DATE:
11/29/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Charmaine BalaoroTIME COMPLETED:
10:45 AM
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Licensing Program Analyst (LPA) Corina Beckby met with Site Director, Charmaine Balaoro, to follow up on the Unusual Incident Reports (UIR) submitted to Community Care Licensing on 11/15/23.

LPA toured the facility, observed the care and supervision of children and conducted interviews.

Facility evaluation report was reviewed and discussed with Site Director. Exit interview was conducted. A Notice of Site Visit was provided and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

In the areas that were evaluated, no deficiencies were cited during today's inspection.
SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Corina Beckby
LICENSING EVALUATOR SIGNATURE: DATE: 11/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/29/2023
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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