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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414001443
Report Date: 10/06/2025
Date Signed: 10/06/2025 05:52:27 PM

Document Has Been Signed on 10/06/2025 05:52 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-LINCOLN ELEMENTARY (SA)FACILITY NUMBER:
414001443
ADMINISTRATOR/
DIRECTOR:		KAYLA GENOCHIOFACILITY TYPE:
840
ADDRESS:1801 DEVEREUX DRIVETELEPHONE:
(650) 697-7400
CITY:BURLINGAMESTATE: CAZIP CODE:
94010
CAPACITY: 131TOTAL ENROLLED CHILDREN: 86CENSUS: 49DATE:
10/06/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:15 PM
MET WITH:Vanessa RomeroTIME VISIT/
INSPECTION COMPLETED:
06:00 PM
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On October 6, 2025 at approximately 3:00PM Licensing Program Analyst, (LPA) Katie Krenn arrived at the facility for an unannounced annual inspection. LPA met with Site Director, Vanessa Romero and explained the purpose of today's visit. Present at the facility in addition to the director were six staff supervising 49 school age children. The facility is operating within capacity limits and ratio during today's visit.

Days and hours of operation: Monday - Friday from 7:00AM to morning school bell; after school dismissal bell until 6:00PM.

Director confirmed that there pools, spas, fountains, ponds, or similar bodies of water on the property.

LPA observed that required documents: such as the facility license, notification of parents’ rights, personal rights, earthquake preparedness checklist, and emergency disaster plan, were available for review in classroom 15. LPA advised the site director to add these postings to additional classrooms where parents pickup and drop off children. Site Director confirmed that she understood.

All children are signed in and out by parents. LPA observed sign in and sign out sheets for October.

The Champion program operates on an active elementary school site. The school age program is exempt from requirements for indoors and outdoors space square footage, fencing, and toilet/sink ratios. No measurements were taken during LPA's visit.

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NAME OF LICENSING PROGRAM MANAGER: Daniel J Oquendo
NAME OF LICENSING PROGRAM ANALYST: Katie Krenn
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 10/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/06/2025
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-LINCOLN ELEMENTARY (SA)
FACILITY NUMBER: 414001443
VISIT DATE: 10/06/2025
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According to the Site Director, the facility does not store or administer any medications. There are some children allergic to nuts, this is a nut free campus.

LPA observed the classrooms to be clean, equipped with age-appropriate furniture and educational materials. Flooring in classroom includes carpet that was observed to be clean and free of stains and tile that had minimal scuff marks and small debris. Classroom includes a fully charged fire extinguisher and an integrated fire alarm system implemented by school district.

LPA observed that children’s belongings are stored in cubbies in the classroom.

LPA inspected the emergency backpack kit with first aid materials. The backpack did not include scissors. Site Director will add scissors.

The facility provides snacks. LPA observed a menu of snacks that included healthy options, such as fresh fruits, vegetables, and whole grains. Drinking water is available for the children both indoors and outdoors.

The outdoor play area is surround by a fence that is at least 4 feet tall. Under the climbing equipment for the older child playground is a rubber-based flooring suitable to cushion falls.

LPA reviewed the scheduled activities which included suitable activities such as outdoor organized or free play, snack time, as well as time for silent reading and homework.

LPA inspected the bathrooms for the children and found them to be clean and functional. Children have separate bathrooms for each gender. There are separate bathrooms available for staff.

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

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NAME OF LICENSING PROGRAM MANAGER: Daniel J Oquendo
NAME OF LICENSING PROGRAM ANALYST: Katie Krenn
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2025
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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: CHAMPIONS-LINCOLN ELEMENTARY (SA)
FACILITY NUMBER: 414001443
VISIT DATE: 10/06/2025
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If you have any questions regarding the process or tools, please send them by email 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.

Director was reminded that all adults 18 and over, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

A notice of site visit was given and must remain posted for 30 days.
Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

No citations were issued during today's visit.

This annual inspection will be completed at a later date.

Exit interview conducted and report was reviewed with the site director, Vanessa Romero.
NAME OF LICENSING PROGRAM MANAGER: Daniel J Oquendo
NAME OF LICENSING PROGRAM ANALYST: Katie Krenn
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2025
LIC809 (FAS) - (06/04)
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