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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414000839
Report Date: 02/20/2026
Date Signed: 02/20/2026 03:35:23 PM

Document Has Been Signed on 02/20/2026 03:35 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-JOHN MUIR ELEMENTARY (SA)FACILITY NUMBER:
414000839
ADMINISTRATOR/
DIRECTOR:		TREVISAN, NOELFACILITY TYPE:
840
ADDRESS:130 CAMBRIDGE LANETELEPHONE:
(650) 797-4310
CITY:SAN BRUNOSTATE: CAZIP CODE:
94066
CAPACITY: 120TOTAL ENROLLED CHILDREN: 120CENSUS: 25DATE:
02/20/2026
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:10 AM
MET WITH:Melanie MurphyTIME VISIT/
INSPECTION COMPLETED:
04:00 PM
NARRATIVE
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On February 20th, 2026, at approximately 9:10am, Licensing Program Analyst (LPA) Tapia-Mandujano conducted a Plan of Correction unannounced visit to the facility. LPA was greeted with Site Supervisor at Allen, Bridget Gauthier and newly hired Site Supervisor, Melanie Murphy and explained the purpose of the visit.

Facility is an afterschool program that is operating full day this week due to Elementary School being out for Ski week. Present during the inspection were five champion staff and 25 school-age children.

LPA observed and verified all staff through Guardian roster and found that there are three Champion staff that are present and are not associated to the facility. On 2/05/26, LPA cited a Type A citation for staff who were also not associated. This is a repeat violation that will result in a Type A citation and civil penalties.

Upon arrival, LPA observed that there was one aide in the classroom with 24 school-age children. On 2/05/26, facility was cited a type B citation for aides not working under the direct supervision of a fully qualified teacher and a separate Type B citation for facility being out of teacher to child ratio. This is a repeat violation that will result in two Type A citations and civil penalties.

Per interview and observation, the staff present are not designated individuals for responsibility at this facility. On 2/05/26 and 2/09/26, LPA cited for not having a site director for this facility. During today’s inspection, there is a newly hired Site Supervisor present at the facility, however LPA has not received any documentation of the change. Facility will receive a type A citation for not having a designated substitute in the absence of the director.

During inspection, LPA went outside and observed two separate children coming out of the classroom, first incident, a staff member stepped out almost immediately. The second incident, LPA observed a child go outside by the classroom doorway and there was no visible staff. Once LPA came back into the classroom, the children were lining up to leave to the Multi-Purpose Room (MPR). Facility has been cited for lack of supervision resulting in children running out of the classroom on 9/15/25. This is a repeat violation that will result in a Type A citation and civil penalties.

Continued on Page 2...

NAME OF LICENSING PROGRAM MANAGER: Marie Rodriguez
NAME OF LICENSING PROGRAM ANALYST: Leslit Tapia-Mandujano
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 02/20/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/20/2026
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: CHAMPIONS-JOHN MUIR ELEMENTARY (SA)
FACILITY NUMBER: 414000839
VISIT DATE: 02/20/2026
NARRATIVE
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Page 2 Continued...

During inspection, LPA reviewed files of children enrolled and present. LPA observed that not all files of the children enrolled and newly enrolled children have the Acknowledgement of Receipt of Licensing Report (LIC 9224) on file. On 2/09/26 and 2/11/26, LPA cited for facility not having this form for the previous Type A citations that were given on 2/05/25, 2/09/26, and 2/11/26. This is a failure to correct citation that will result in a Type A citation and civil penalties.

During inspection, LPA handed a letter to Melanie Murphy containing the date for the mandatory office meeting.

LPA Tapia-Mandujano informed newly hired Site Supervisor, Melanie Murphy that this report dated 2/20/26 documents six Type A citations which shall be posted for 30 consecutive days as there are immediate risks to the health, safety, or personal rights of children in care.

Also, LPA Tapia-Mandujano informed newly hired Site Supervisor, Melanie Murphy to provide a copy of this licensing report dated 2/20/26 that documents any Type A citations to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

Deficiencies were cited today under Title 22 Division 12 of the Ca. Code of Regulations.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with newly hired Site Supervisor, Melanie Murphy.

NAME OF LICENSING PROGRAM MANAGER: Marie Rodriguez
NAME OF LICENSING PROGRAM ANALYST: Leslit Tapia-Mandujano
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 02/20/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2026
LIC809 (FAS) - (06/04)
Page: 3 of 6
Document Has Been Signed on 02/20/2026 03:35 PM - It Cannot Be Edited


Created By: Leslit Tapia-Mandujano On 02/20/2026 at 01:17 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: CHAMPIONS-JOHN MUIR ELEMENTARY (SA)
FACILITY NUMBER: 414000839

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/20/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/23/2026
Section Cited
CCR
101216(i)(2)

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101216 Personnel Requirements: "(i) Prior to employment or initial presence in the child care center, all employees and volunteers subject to a criminal record review shall: (2) Request a transfer of a criminal record clearance...:

This requirement is not met as evidenced by:
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Facility must submit a transfer request form to associate the three staff that are cleared but not associated with the facility.

Facility must submit this form by 2/23/26 to the San Bruno Regional office.
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Based on observation, interview, and record review, the facility did not comply as there are three champion staff that are not associated with this site. This poses an immediate health, safety or personal rights risk to persons in care.
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Civil penalties were assessed.
Type A
02/23/2026
Section Cited
CCR101516.5(b)(1)

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101516.5: Teacher-Child Ratio:" (b) There shall be a staffing ratio of one teacher and one aide present to every 28 children in attendance.(1) A teacher shall supervise no more than 14 children or with an aide a maximum of 28 children."

This requirement is not met as evidenced by:
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Fully qualified staff stepped in from the classroom once LPA was announced of being at the facility.

Facility must create policies and procedures to ensure that teacher to child ratio is met all times.
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Based on observation, the facility did not comply with the section cited above as upon arrival, LPA observed that there were 24 school age children with one teacher aide in the classroom. This poses an immediate health, safety or personal rights risk to persons in care.
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Written plan of policies and procedures must be submitted to the San Bruno Regional office by 2/23/26.

Civil penalties were assessed.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Marie Rodriguez
NAME OF LICENSING PROGRAM MANAGER:
Leslit Tapia-Mandujano
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 02/20/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/20/2026


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 02/20/2026 03:35 PM - It Cannot Be Edited


Created By: Leslit Tapia-Mandujano On 02/20/2026 at 01:27 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: CHAMPIONS-JOHN MUIR ELEMENTARY (SA)
FACILITY NUMBER: 414000839

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/20/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/23/2026
Section Cited
CCR
101216.2(e)

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101216.2:Teacher Aide Qualifications and Duties:(e)An aide shall work only under the direct supervision of a teacher.

This requirement is not met as evidenced by:
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Fully qualified staff stepped in from the classroom once LPA was announced of being at the facility.

Facility must submit a written plan on how they will ensure that aides are working under the direct supervision of a fully qualified teacher.
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Based on observation, the facility did not comply with the section cited above as upon arrival, LPA observed that there was teacher aide supervising 24 school age children without the direct supervision of a fully qualified teacher. This poses an immediate health, safety or personal rights risk to persons in care.
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Written plan of policies and procedures must be submitted to the San Bruno Regional office by 2/23/26.

Civil penalties were assessed.
Type A
02/23/2026
Section Cited
CCR101215.1(f)

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101215.1: Child Care Center Directors Qualifications and Duties:" (f) When the child care center director is absent from the center, arrangements shall be made... to act as substitute. This substitute child care center director shall be aware of center operations, including total enrollment; shall be trained in program operation; and shall be designated as an authorized person to correct operational deficiencies that constitute immediate threats to children's health and safety.

This requirement is not met as evidenced by:
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Facility must submit paperwork for the newly hired site supervisor for this site to the San Bruno Regional office by 2/23/26.
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Based on observation, interview, and record review, the facility did not comply with the section cited above as staff members present in the absence of a director are not designated to be responsible at the facility. This poses an immediate health, safety or personal rights risk to persons in care.
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Designation of Responsibility must be submitted and must be an individual who will be present at this facility during operational hours.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Marie Rodriguez
NAME OF LICENSING PROGRAM MANAGER:
Leslit Tapia-Mandujano
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 02/20/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/20/2026


LIC809 (FAS) - (06/04)
Page: 5 of 6
Document Has Been Signed on 02/20/2026 03:35 PM - It Cannot Be Edited


Created By: Leslit Tapia-Mandujano On 02/20/2026 at 01:48 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: CHAMPIONS-JOHN MUIR ELEMENTARY (SA)
FACILITY NUMBER: 414000839

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/20/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/23/2026
Section Cited
CCR
101229(a)(1)

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101229: Responsibility for Providing Care and Supervision: "(a) The licensee shall provide care and supervision as necessary to meet the children's needs.(1) No child(ren) shall be left without the supervision...Supervision shall include visual observation."

This requirement was not met as evidenced by..
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Staff were made aware of the situation.

Facility must submit a written plan on how they will ensure that each child is being supervised and steps to mitigate children from running inside/outside of the classroom without the supervision of a staff.
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Based on observation, the facility did not comply with the section cited above as LPA observed two separate incidents where children ran out of the classroom without the supervision of staff. This poses an immediate health, safety or personal rights risk to persons in care.
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Written plan of policies and procedures must be submitted to the San Bruno Regional office by 2/23/26.

Civil penalties were assessed.
Type A
02/23/2026
Section Cited
HSC1596.8595(c)(1)(3)

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1596.8595: "(c)(1) A licensed child day care facility shall provide to the parents or guardians of each child receiving services in the facility copies of any licensing report that documents any Type A citation... (3) The licensee shall require each recipient of the licensing report described in paragraph (1) pertaining to a complaint investigation to sign a statement indicating that he or she has received the document and the date it was received."

This requirement is not met as evidence by:
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Facility must obtain LIC 9224 for each child enrolled at the facility.

LIC 9224 will be submitted to LPA Tapia-Mandujano with a copy of children’s roster by the end of day on 2/23/26.
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Based on observation, interview, and record review, the facility did not comply as the facility did not have LIC 9224 of all children enrolled and newly enrolled children from the past three reports that document Type A citations. This poses a potential health, safety or personal rights risk to persons in care.
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Civil penalties were assesed.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Marie Rodriguez
NAME OF LICENSING PROGRAM MANAGER:
Leslit Tapia-Mandujano
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 02/20/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/20/2026


LIC809 (FAS) - (06/04)
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