<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414000081
Report Date: 06/18/2024
Date Signed: 06/18/2024 05:05:58 PM

Document Has Been Signed on 06/18/2024 05:05 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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:CHAMPIONS-LAS LOMITAS ELEMENTARY (PS)FACILITY NUMBER:
414000081
ADMINISTRATOR/
DIRECTOR:
PFEIFFER, SHARONFACILITY TYPE:
850
ADDRESS:299 ALAMEDA DE LAS PULGASTELEPHONE:
(650) 250-3658
CITY:ATHERTONSTATE: CAZIP CODE:
94027
CAPACITY: 55TOTAL ENROLLED CHILDREN: 16CENSUS: 0DATE:
06/18/2024
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
04:00 PM
MET WITH:Director, Sharon PfeifferTIME VISIT/
INSPECTION COMPLETED:
05:30 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On June 18th, 2024 at approximately 4pm, Licensing Program Analyst (LPA) Tapia-Mandujano made an unannounced case management-licensee initiated visit to decrease capacity from 55 to 26 preschool age children and to change rooms. LPA met with Director, Sharon Pfeiffer, and Site Supervisor. Present in the facility are Director and Site Supervisor. Facility is currently on Summer Break and there are no preschool age children present. Department received Fire Clearance that was approved on 6/12/24 by the Menlo Park Fire Department.

During the inspection, Room 605 was inspected for health and safety hazards. LPA measured room 605 to measure for 915.79 sqft. allowing for 26 preschool age children in the classroom. The classroom has a fire alarm, a smoke and carbon monoxide detector, and will get a fully charged fire extinguisher. The facility has age appropriate toys, furniture, and equipment displayed for children. There are storage spaces for children's personal belongings located inside of the classroom. Room 605 only has 1 restroom and 1 sink. In the classroom, there is an additional sink. Waiver Request for an additional toilet is in process. Facilities outdoor space will remain the same.

During today's inspection, LPA received the following documents: LIC 610, Admissions Agreement, and an updated Restroom Waiver.

LPA will approve the decrease of capacity and the room change to Room 606, once the following is completed:
*Fire Extinguisher for the classroom
*Restroom Waiver approved
*Lead testing and results posted or approved attestation by the department for exemption of lead testing

No deficiencies are cited today under the California Code of Regulations, Title 22, Division 12.

Notice of Site Visit is provided and must remain posted for 30 days.

A copy of the report was reviewed and discussed with the Director, Sharon Pfeiffer.
SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Leslit Tapia-Mandujano
LICENSING EVALUATOR SIGNATURE: DATE: 06/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/18/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1