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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015700540
Report Date: 07/28/2023
Date Signed: 07/28/2023 05:34:14 PM

Document Has Been Signed on 07/28/2023 05:34 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 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: 32DATE:
07/28/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Elizabeth BrodowskiTIME COMPLETED:
05:45 PM
NARRATIVE
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 Licensing Program Analyst (LPA) Andrew Elliot met with Director Elizabeth Brodowski for an unannounced Annual Random Inspection at 11:00 am on 07/28/2023. LPA disclosed the purpose of the inspection and was granted entry into the facility by the director. In addition to the director, there are 31 children and 4 staff present today Specifically, there are 2 fully qualified teacher and 1 teacher’s aide and 1 volunteer. The facility’s hours of operation are M-F 7:30am to 5:30pm. LPA observed that a teacher’s aide was working alone in a classroom with six preschool aged children without the supervision of a fully qualified teacher. Six students were left without the supervision of a fully qualified teacher as a result. This is a violation of CCR 101291(a)(1) and CCR 101216.2(e). LPA informed the director that a teacher’s aide could not work with children without being directly supervised by a fully qualified teacher at all times.
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.
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Andrew Elliott
LICENSING EVALUATOR SIGNATURE: DATE: 07/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/28/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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Document Has Been Signed on 07/28/2023 05:34 PM - It Cannot Be Edited


Created By: Andrew Elliott On 07/28/2023 at 03:02 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
, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: ADVENTURE MONTESSORI ACADEMY
FACILITY NUMBER: 015700540

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/28/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101229(a)(1)
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 of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and file review, the licensee did not comply with the section cited above in 6 out of 31 which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/31/2023
Plan of Correction
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As of 07/31/2023, S4 will not work with children without the direct visual supervision of a fully quaiflied teacher.
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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4
Based on record review, the licensee did not comply with the section cited above in 2 of 4 which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/31/2023
Plan of Correction
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Both the Director and S1 will send proof to LPA that they have completed the Mandated Reporter Training by 08/31/2023. The director will send the completion certification via email for both herself and S1 to LPA by the aforementioned date.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Wynn Norona
LICENSING EVALUATOR NAME:Andrew Elliott
LICENSING EVALUATOR SIGNATURE:
DATE: 07/28/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/28/2023


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Document Has Been Signed on 07/28/2023 05:34 PM - It Cannot Be Edited


Created By: Andrew Elliott On 07/28/2023 at 03:02 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
, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: ADVENTURE MONTESSORI ACADEMY
FACILITY NUMBER: 015700540

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/28/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101216.2(e)
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:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above in 1 out of 1 count, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/31/2023
Plan of Correction
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4
S4 will not work with children without the direct visual supervision of a fully quailifed teacher as of 07/31/2023.
Section Cited
Deficient Practice Statement
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4
POC Due Date:
Plan of Correction
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4
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Wynn Norona
LICENSING EVALUATOR NAME:Andrew Elliott
LICENSING EVALUATOR SIGNATURE:
DATE: 07/28/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/28/2023


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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 MONTESSORI ACADEMY
FACILITY NUMBER: 015700540
VISIT DATE: 07/28/2023
NARRATIVE
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 The classroom has appropriate postings. The last Emergency Drill was conducted on 03/09/2023 and is properly logged. The Outdoor play area featured 1 play structure which was damaged and made inaccessible to children by being roped off with duct type in addition adult supervision. Otherwise 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. Multiple first aid kits available. There is a working fire alarm system in the facility, and a carbon monoxide detector is present in each room. There are 3 2A40CBC model fire extinguishers, all of which are fully charged and a working telephone available. All children have a record of emergency identification information and immunization record on file. LPA reviewed staff records. Both director and one of the fully qualified teachers have expired mandated reporter training certificates. Mandated reporter training must be repeated every two years, and both the director and 1 fully qualified teacher last completed their mandated reporter training in March of 2021. This is a violation of HSC 1596.8662(b)(1) 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.
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 director 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.
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Andrew Elliott
LICENSING EVALUATOR SIGNATURE:

DATE: 07/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2023
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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 MONTESSORI ACADEMY
FACILITY NUMBER: 015700540
VISIT DATE: 07/28/2023
NARRATIVE
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 Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test.
For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1- CCP).
LPA verified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP.
Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02- CCP. When any IMS is provided, an updated Plan of Operation that includes 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) 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-care-centers. Director was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.
3 Type deficiencies were cited today.
1. A Type B Violation is issued for violation of CCR 101291(a)(1) – Six Children were left without the supervision of a Fully Qualified Teacher
2. A Type B Violation is issued for violation of CCR 101216.2(e)- 1 Teachers Aide was working with children without the visual supervision of a Fully Qualified Teacher
3. A Type Violation is issued for violation of HSC 1596.8662(b)(1) – The Director and 1 Teacher have expired Mandated Reporter Training requirements.
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: Andrew Elliott
LICENSING EVALUATOR SIGNATURE:

DATE: 07/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2023
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