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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414000839
Report Date: 02/25/2026
Date Signed: 02/25/2026 05:46:16 PM

Document Has Been Signed on 02/25/2026 05:46 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: 79DATE:
02/25/2026
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:55 PM
MET WITH:Gesmyne BellTIME VISIT/
INSPECTION COMPLETED:
06:20 PM
NARRATIVE
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On February 25th, 2026, at approximately 12:55pm, Licensing Program Analyst (LPA) Tapia-Mandujano conducted a Plan of Correction unannounced visit to the facility. LPA was greeted with Site Supervisor, Melanie Murphy and explained the purpose of the visit. Present during the inspection were a total of four champion staff and four Child Care Careers (CCC) substitutes supervising a total of 79 school age children.

At approximately 1:45pm, LPA observed Acting Director, Gesmyne Bell arrive to the facility. Per Gesmyne, she went to submit paperwork to CCLD office. LPA explained the purpose of the visit to Gesmyne Bell.

At approximately 1:35pm, LPA started to walked through the classrooms to count the children and staff. At approximately 1:40pm, LPA observed the cafeteria/multipurpose room had 29 ( 3rd-5th) school age children with one champion aide and one CCC sub that has no units. Facility has been cited for over capacity and aides not working under direct supervision of a teacher on multiple occasions. These are two separate failures to correct violations that will result in two Type A citations and civil penalties. LPA also observed a cooking class that is not part of champions in the cafeteria/Multipurpose room with champion children and staff.

LPA observed and verified all staff through Guardian roster and found that there are still two Champion staff that are present and are not associated to the facility. LPA has cited this facility on 2/05/26 and 2/20/26. This is a failure to correct and repeat violation that will result in a Type A citation and civil penalties.

During inspection, LPA was typing the report in the classroom and observed children walking into the classroom without any staff present. LPA cited for lack of supervision on 2/20/26. This is a failure to correct 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: 02/25/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/25/2026
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: 02/25/2026
NARRATIVE
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Page 2 Continued...

LPA observed that the report from 2/20/26 was not fully posted. On 2/20/26 LPA provided a five-page report and only three pages of the report was posted. This is a repeated violation and will result in civil penalties.

LPA also reviewed children files and observed that there are still children who are missing the LIC 9224 for 2/05/26, 2/09/26, 2/11/26, and 2/20/26. Per Gesmyne, the children that were enrolled last week did not get the LIC 9224 with a copy of the report for those dates. This is a repeated violation and will result in civil penalties.

LPA Tapia-Mandujano informed acting Site Director, Gesmyne Bell that this report dated 2/26/26 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 acting Site Director, Gesmyne Bell to provide a copy of this licensing report dated 2/26/26 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 Acting Director, Gesmyne Bell.

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

DATE: 02/25/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/25/2026
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 02/25/2026 05:46 PM - It Cannot Be Edited


Created By: Leslit Tapia-Mandujano On 02/25/2026 at 02:53 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: 02/25/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/26/2026
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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Transfer Request for the two staff that are cleared but not associated will be emailed by the end of day today, 2/26/26.

Per Gesmyne, moving forward she now has access to Guardian and she will associate any individual as needed.
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Based on observation, interview, and record review, the facility did not comply as there are two 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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A written stament of above will be submitted to the San Bruno Regional Office by 2/26/26.

Civil penalties were assessed.
Type A
02/26/2026
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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Acting Site Director arrived at approximately 1:45pm. Ratio was still not met.

Written policies that have been previously submitted were not met.
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Based on observation, the facility did not comply with the section cited above as LPA observed there were 29 school age children in the cafeteria with two aides. This poses an immediate health, safety or personal rights risk to persons in care.
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Per Gesmyne, acknowledges that she understands the teacher to child ratio. Per Gesmyne, they will need to be strategic to follow the ratio. Per Gesmyne, if staff need to step out child would be moved to another classroom to follow teacher to child ratio.

A written stament of above will be submitted to the San Bruno Regional Office by 2/26/26.

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: 02/25/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/25/2026


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 02/25/2026 05:46 PM - It Cannot Be Edited


Created By: Leslit Tapia-Mandujano On 02/25/2026 at 03:03 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: 02/25/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/26/2026
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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Acting Site Director arrived at approximately 1:45pm being in compliance for aides to work under a fully qualified staff.

Written policies that have been previously submitted were not met.
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Based on observation and record review, the facility did not comply with the section cited above as upon arrival, LPA observed that there were two aides supervising 29 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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Per Gesmyne, she has hired a fully qualified staff to start as of next week. Per Gesmyne, she is also working on transferring over another staff who is fully qualified to be as a back up.

A written stament of above will be submitted to the San Bruno Regional Office by 2/26/26.

Civil penalties were assessed.
Type A
02/26/2026
Section Cited
CCR101229(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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LPA did not receive a written plan to correct this citation when cited on 2/2026.

Per Gesmyne, staff will go over class expectations with all children for children to be made aware of them not being out of sight of a staff. Per Gesmyne, staff will be positioned by the ramp to ensure children are not coming in the classroom.
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Based on observation, the facility did not comply with the section cited above as LPA observed children coming into 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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A written stament of above will be submitted to the San Bruno Regional Office by 2/26/26.

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: 02/25/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/25/2026


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 02/25/2026 05:46 PM - It Cannot Be Edited


Created By: Leslit Tapia-Mandujano On 02/25/2026 at 03:27 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: 02/25/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/26/2026
Section Cited
HSC
1596.8595(a)(1)

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1596.8595(a): "a)(1) Each licensed child day care facility shall post a copy of any licensing report pertaining to the facility that documents either a facility visit...that results in a citation for a violation that...immediate risk to the health, safety, or personal rights of children in care. The licensing report provided by the department shall be posted immediately upon receipt, adjacent to the postings required... and on, or immediately adjacent to, the interior side of the main door to the facility and shall remain posted for 30 consecutive days."

This requirement is not met as evidence by:
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Facility was made aware that the entire report from 2/20/26 that documents 6 Type As was not posted correctly.

The missing pages of the report must be posted. LPA observed the missing pages to be posted.
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Based on observation, the facility did not comply as the facility did not have the entire report that documents a Type A citation posted from 2/202/6. This poses a potential health, safety or personal rights risk to persons in care.
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Per Gesmyne, she will go over all the reports and make sure that the complete reports are posted and posted together.

A written stament of above will be submitted to the San Bruno Regional Office by 2/26/26.

Civil penalties were assessed.
Type A
02/26/2026
Section Cited
HSC1596.8595(c)(1)(3)

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1596.8595(c)(1)(3): "(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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Per Gesmyne, upon pick up parents will be handed the LIC 9224 of all reports and obtain a signature. Per Gesmyne, files will make a note of children who are enrolled and not attending program.
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Based on observation, interview, and record review, the facility did not comply as the facility still has to give the LIC 9224s for some children and the newly enrolled children from Allen Site. This poses a potential health, safety or personal rights risk to persons in care.
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A written stament of above will be submitted to the San Bruno Regional Office by 2/26/26.
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: 02/25/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/25/2026


LIC809 (FAS) - (06/04)
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