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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015700540
Report Date: 06/16/2022
Date Signed: 06/16/2022 02:03:48 PM

Document Has Been Signed on 06/16/2022 02:03 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
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:ADVENTURE MONTESSORI ACADEMYFACILITY NUMBER:
015700540
ADMINISTRATOR:BRODOWSKI, ELIZABETHFACILITY TYPE:
850
ADDRESS:4101 PLEIADES PLACETELEPHONE:
(408) 464-3131
CITY:UNION CITYSTATE: CAZIP CODE:
94587
CAPACITY: 60TOTAL ENROLLED CHILDREN: 60CENSUS: 35DATE:
06/16/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Director, Elizabeth BrodowskiTIME COMPLETED:
02:20 PM
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Licensing Program Analyst (LPA) Jyoti Saini met with Director Elizabeth Brodowski for an unannounced Annual Random Inspection. LPA disclosed the purpose of the inspection and was granted entry into the facility by the director. In addition to the director, there are 35 children and 4 staff present today. The facility’s hours of operation are M-F 7:30am to 5:30pm.The facility was inspected indoor and outdoor today for health and safety hazards and the following was observed;

There are no bodies of water, firearms, or weapons on premises. The center is in good condition with proper temperature and ventilation and is free of any hazards. All furniture is in good repair. The Center has age-appropriate toys and equipment. The children and staff have a separate bathroom. There are 6 toilets and 7 sinks available for children. The bathrooms appear to be safe, sanitary, and free of any hazardous items. There is drinking water readily available. There is a menu posted for the entire month. The facility has a kitchen and no cleaners or toxic materials were observed stored with food. Facility provides AM/PM snacks and Children bring lunch from home. The isolation area is director’s office.

The classroom has appropriate postings. The last Emergency Drill was conducted on 04/12/2022 and is properly logged. Outdoor play area was free of hazards and provided a shaded area for the children.

LPA reviewed sign-in and out sheet. The center has a complete record of sign-in/out sheets by an authorized pick up person. There are multiple first aid kits available. There is a working fire alarm system in the facility. The room has a working smoke and carbon monoxide detector, a fully charged fire extinguisher, and a working telephone available. All children have a record of emergency identification information and immunization record on file. LPA reviewed staff record. All staff has a criminal record clearance on file. The opening and closing teacher has a current Pediatric First Aid/CPR certificate on file. LPA reviewed the facility roster and obtained a copy of the roster.

see next page..

SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Jyoti Saini
LICENSING EVALUATOR SIGNATURE: DATE: 06/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/16/2022
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: ADVENTURE MONTESSORI ACADEMY
FACILITY NUMBER: 015700540
VISIT DATE: 06/16/2022
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During inspection,

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.

• Site Director was reminded as of September 1, 2016, all Staff and Volunteers must provide proof of immunization against pertussis, measles, and influenza, or qualifies for an exemption, pursuant to Health and Safety code 1596.7995 and 1597.662.

• Site Director was reminded about Mandated Reporter Training available on the CCLD website. Training must be completed every two years. (Websites: www.ccld.ca.gov or www.mandatedreporterca.com)

Incidental Medical Services (IMS) policy was discussed. This facility does not provide IMS (Incidental Medical Services) to children currently. If any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

To improve the quality and value of the new inspection process, a survey will 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 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/process.

No deficiencies were 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 director, Elizabeth Broodowski

SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Jyoti Saini
LICENSING EVALUATOR SIGNATURE:

DATE: 06/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2022
LIC809 (FAS) - (06/04)
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