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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343611165
Report Date: 08/28/2024
Date Signed: 08/28/2024 10:51:59 AM

Document Has Been Signed on 08/28/2024 10:51 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/
DIRECTOR:		CHARMAINE BALAOROFACILITY TYPE:
840
ADDRESS:9850 FIRE POPPY DRIVETELEPHONE:
(916) 690-8718
CITY:ELK GROVESTATE: CAZIP CODE:
95757
CAPACITY: 100TOTAL ENROLLED CHILDREN: 100CENSUS: DATE:
08/28/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:15 AM
MET WITH:Charmaine BalaoroTIME VISIT/
INSPECTION COMPLETED:
11:15 AM
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On August 28, 2024, Licensing Program Analyst’s (LPA’s) Corina Beckby and Deborah Khashe met with Site Director, Charmaine Balaoro for an unannounced required annual random inspection. LPA’S observed 2 teachers with no children were present. Facility operates Monday through Friday from 6:30AM to 6:00PM during Summer and Spring Break, in three portable classrooms.

LPA’S inspected all activity and classroom spaces, restrooms, food service, and outdoor play areas. Hazardous items are inaccessible to children. Furniture and equipment are in operable and safe condition. Playground equipment and surfaces are free of loose or sharp parts, and adequate cushioning was observed in areas underneath climbing equipment. 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 in each classroom. Medications are stored in a central location. LPA’s observed a functional carbon monoxide detector.

Afternoon snacks are provided by the facility. LPA’S observed posted menus showing planned meals at least one week in advance. Noncontaminated Drinking water is readily available to children both indoors and outdoors.

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every



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SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Corina Beckby
LICENSING EVALUATOR SIGNATURE: DATE: 08/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/28/2024
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 @ HELEN CARR CASTELLO ELEMENTARY
FACILITY NUMBER: 343611165
VISIT DATE: 08/28/2024
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5-years after the date of the first test. For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1-CCP). LPA’Sverified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP. LPA’S referred Facility Representative to the Department website for lead: Lead Toxicity Prevention and Water Testing Information.

LPA’S observed full legal signatures while reviewing the sign in and sign out sheet. LPA’S reviewed records for all present staff. Current Pediatric CPR and First Aid certification which expires 06/2026. All staff currently employed with the facility have: a criminal record clearance, a health screening report, immunization records, documentation of their educational background, training, and/or experience. LPA’S did not observe current AB1207 Mandated Reporter Training in staff files. Ten Children records were reviewed. Each child's file contained a completed emergency contact form, immunization records, signed personal rights form, and a completed medical assessment.

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 PIN 22-02-CCP. 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 are available at: https://www.ada.gov/resources/child-care-centers/.

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection




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SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Corina Beckby
LICENSING EVALUATOR SIGNATURE:

DATE: 08/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2024
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 @ HELEN CARR CASTELLO ELEMENTARY
FACILITY NUMBER: 343611165
VISIT DATE: 08/28/2024
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experience. If you have any questions regarding the process or CARE tools, please send email inquiries 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/inspection-process.

All individuals subject to criminal record review have obtained clearance. Licensing Representative was reminded that all adults 18 and over, 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.

Facility Representative was informed of the MyChildCarePlan.org website; 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.

No deficiencies were observed during today’s visit.

Exit interview conducted and report was reviewed with the Site Director, Charmaine Balaoro. 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. Appeal Rights were provided.

SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Corina Beckby
LICENSING EVALUATOR SIGNATURE:

DATE: 08/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2024
LIC809 (FAS) - (06/04)
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