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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 010214922
Report Date: 02/26/2024
Date Signed: 02/26/2024 01:11:36 PM

Document Has Been Signed on 02/26/2024 01:11 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:ADVENTURE TIME - BROOKVALEFACILITY NUMBER:
010214922
ADMINISTRATOR:GRACE SYFACILITY TYPE:
840
ADDRESS:3400 NICOLET AVENUETELEPHONE:
(510) 797-5180
CITY:FREMONTSTATE: CAZIP CODE:
94536
CAPACITY: 115TOTAL ENROLLED CHILDREN: 115CENSUS: 5DATE:
02/26/2024
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
11:05 AM
MET WITH:Grace SyTIME COMPLETED:
01:30 PM
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On February 26, 2024 at 11:05 AM., Licensing Program Analyst (LPA) Elimika Woods conducted an unannounced 3 Year Required Inspection and met with the facility representative, Grace Sy. LPA disclosed the purpose of the inspection and was granted entry into the facility by the facility representative. There were five (5) school age children present during this inspection and one (1) additional staff member. The facility operates on the campus of Brookvale elementary school in a single portable classroom. The hours of operation are 7:00 AM-8:30 AM and 11:30 AM-6:00 PM, Monday -Friday

The facility was toured inside and out for a health and safety inspection. LPA checked the facility RECORDS and they show all individuals subject to criminal record review have a clearance or exemption and have been associated to the facility. LPA conducted a census of the children and the census matches the children signed in on the sign in sheet. LPA reviewed two (2) children's files around 11:30 AM.

The one (1) classroom was inspected around 11:45 AM and teacher child ratio was observed. The facility representative confirmed that the isolation area for sick children is next to the director's desk, away from other children in care. LPA inspected the furniture, floors, and carpets and they were in good repair. The children’s equipment, play and leaning materials are adequate and available. Each child has their own individual space for storage and drinking water is available inside and outside. The center has wired smoke detectors, working carbon monoxide detector, working telephone, pull down fire alarm system, and a fully charged 3A40BC fire extinguisher which meets standards established by the State Fire Marshal. Disaster drills are being conducted at least once every 6 months and the last one conducted was on 01/29/2024. All required documents are posted in a public accessible area.

LPA reviewed the facility roster and obtained a copy. At least one opening/ closing staff member has a current CPR & First Aid Certificate. Mandated Reporter Training was discussed, and certificates were reviewed.

See 809- C

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Elimika Woods
LICENSING EVALUATOR SIGNATURE: DATE: 02/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/26/2024
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 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: ADVENTURE TIME - BROOKVALE
FACILITY NUMBER: 010214922
VISIT DATE: 02/26/2024
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This facility provides Incidental Medical Services – IMS. LPA reviewed storage of “medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see PIN 22-02-CCP. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514-0383 (TTY) and link to publication. Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-carecenters/.

LPA reminded the facility representative that a refrigerator shall be used to store any medications that requires refrigeration.

This facility provides snacks and lunch for the children. There are weekly menus posted at the facility. The center has a refrigerator that's kept clean a free of rodents and trash. Pesticides and other similar toxic substances are not stored in cabinets that contains food. All storage containers for solid waste have tight fitting covers that are in good repair.

The outdoor play area is the school yard and playground which is in safe condition and free from sharp, loose or pointed parts. The play equipment is age appropriate and in good repair. The playground has a large play structure with a slide that's anchored to the ground with cushioning underneath to absorb children falls. The staff brings the children cups and water bottles to the playground to keep them hydrated and there are trees for shade around the playground.



LPA Observations

When the children arrived to the classroom LPA Woods observed that the facility staff prepared their lunch and snacks for the children before taking some of them to the restroom. The staff also engaged with the children in conversation and asked the children about their weekend.

The staff's bathroom is separate from the children's bathroom and all of the sinks and toilets faucets are in safe and sanitary operating condition. The children can reach the sinks and toilets and the paper towels and soap are available to the children.

California Law requires Child Care Centers licensees to report unusual incidents or injuries to children in care to child's parents and to the Department of Social Services using the Unusual Incident/Injury form (LIC 624). Incidents must be reported within 24 hours by phone, fax, or electronic mail. The facility representative was also reminded that Mandated Reporter Training ("General" and "Child Care Providers") is required for all staff and is to be renewed every 2 years by visiting www.mandatedreporterca.com.

See 809-C

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Elimika Woods
LICENSING EVALUATOR SIGNATURE:

DATE: 02/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/26/2024
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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: ADVENTURE TIME - BROOKVALE
FACILITY NUMBER: 010214922
VISIT DATE: 02/26/2024
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To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries 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.

The facility representative was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

The facility representative was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

There are no deficiencies cited today. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the facility representative Grace Sy.

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Elimika Woods
LICENSING EVALUATOR SIGNATURE:

DATE: 02/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/26/2024
LIC809 (FAS) - (06/04)
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