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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434406721
Report Date: 10/10/2024
Date Signed: 10/10/2024 01:49:01 PM

Document Has Been Signed on 10/10/2024 01:49 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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:CHAMPIONS - COVINGTON ELEMENTARYFACILITY NUMBER:
434406721
ADMINISTRATOR/
DIRECTOR:		JERMELL ROWLANDFACILITY TYPE:
840
ADDRESS:201 COVINGTON ROADTELEPHONE:
(650) 559-7900
CITY:LOS ALTOSSTATE: CAZIP CODE:
94024
CAPACITY: 50TOTAL ENROLLED CHILDREN: 50CENSUS: DATE:
10/10/2024
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:30 PM
MET WITH:Brittany BeckTIME VISIT/
INSPECTION COMPLETED:
02:00 PM
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On 10/10/2024 at 1:30pm, Licensing Program Analyst (LPA) Christina Uribe met with Area Manager, Brittany Beck, for the purpose of an announced Case Management Visit regarding the application for adding an additional classroom with no change to the current capacity of 50.

The required application and all corresponding documents were received prior to today's inspection. The Santa Clara County Fire Department performed the required fire clearance inspection and the additional room was granted a fire clearance on 09/18/2024.

The additional room is located in a portable, a short distance from the existing classroom. LPA Uribe toured the additional classroom for a health and safety inspection. The additional classroom was inspected for age-appropriate furnishings, equipment, & adequate storage for children’s belongings. LPA observed the cleanliness of floors & surfaces, the presence of a fully functional carbon monoxide detector, smoke detector/fire alarms, and a fully charged 3A40BC fire extinguisher that is accessible throughout the facility.

The request by the facility to add an additional classroom is approved for use effective today, 10/10/2024. A new license will be mailed to the facility with updated comments section to reflect the use of the existing classroom and the classroom added today. Facility is required to post the new license in a prominent area for public review at all times.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Area Manager, Brittany Beck.

Page 1 of 1 ***End of Report***
SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Christina Uribe
LICENSING EVALUATOR SIGNATURE: DATE: 10/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/10/2024
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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