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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343624323
Report Date: 08/29/2023
Date Signed: 08/29/2023 03:45:38 PM

Document Has Been Signed on 08/29/2023 03:45 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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:ADVENTURE MONTESSORI S.T.E.A.M ACADEMY LLCFACILITY NUMBER:
343624323
ADMINISTRATOR:ROBERTA MANLEYFACILITY TYPE:
830
ADDRESS:3541 N FREEWAY BLVD SUITE 100TELEPHONE:
(916) 370-6113
CITY:SACRAMENTOSTATE: CAZIP CODE:
95835
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 8DATE:
08/29/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Silhumini MillawabandarTIME COMPLETED:
04:00 PM
NARRATIVE
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On 8/29/23, Licensing Program Analysts (LPAs) Arianna Manabat and Kyrsten Williams met with Director Sithumini Millawabandara for an unannounced annual inspection. At 11:15am LPA toured the facility including all activity and classroom spaces, restrooms, food service and outdoor play areas. Today’s census included 8 infant children being supervised by 2 staff members. The Director was reminded never to exceed the conditions, limitations and capacity specified on the license. Facility hours of operation are Monday through Friday 7:00 AM – 6:00 PM.

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.

LPAs observed that all classrooms appeared clean including the carpets and floor. Furniture and equipment are in good condition, and toileting facilities are in safe, sanitary, and operating condition. LPAs observed a functional carbon monoxide detector. Chemicals and cleaning materials were kept inaccessible to children. The food preparation space is free of litter and all food was protected against contamination. Trash cans have tight fitting lids. Medications are stored in an area inaccessible to children. The Director stated there are no poisons, bodies of water, or weapons on the premises.

Playground equipment and surfaces were inspected and are in good condition with enough resilient material under climbing structures to absorb a fall. Shade was provided to children via awnings and the sides of the building. Drinking water was readily available to children both indoors and outdoors in water bottles and pitchers. Continued on LIC 809-C.....
SUPERVISORS NAME: Amanda Blesi
LICENSING EVALUATOR NAME: Arianna Manabat
LICENSING EVALUATOR SIGNATURE: DATE: 08/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/29/2023
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 08/29/2023 03:45 PM - It Cannot Be Edited


Created By: Arianna Manabat On 08/29/2023 at 01:28 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
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: ADVENTURE MONTESSORI S.T.E.A.M ACADEMY LLC
FACILITY NUMBER: 343624323

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/29/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101237(a)
101237 Alterations to Existing Buildings or New Facilities
(a) Prior to construction or alterations, the licensee shall notify the Department of the proposed change(s).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, and record review, the licensee did not comply with the section cited as they did not submit notification of adding in a half wall to the infant space for cribs. This has reduced the size of the room. Failure to report this physical change poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/12/2023
Plan of Correction
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Licensee will submit a LIC200A to the Regional Office for this change.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Amanda Blesi
LICENSING EVALUATOR NAME:Arianna Manabat
LICENSING EVALUATOR SIGNATURE:
DATE: 08/29/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/29/2023


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Document Has Been Signed on 08/29/2023 03:45 PM - It Cannot Be Edited


Created By: Arianna Manabat On 08/29/2023 at 02:09 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
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: ADVENTURE MONTESSORI S.T.E.A.M ACADEMY LLC
FACILITY NUMBER: 343624323

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/29/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101218.1(c)
Admission Procedures and Parental and Authorized Representative's Rights
(c) The licensee shall post the PUB 393 (8/02), Child Care Center Notification of Parents' Rights Poster in a prominent, publicly accessible area in the child care center at all times.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and record review, the licensee did not comply with the section cited above as LPAs did not observe the Parents' Rights Poster posted, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/12/2023
Plan of Correction
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The Director will post the Parents' Rights Poster in an area visible to the public.
Type B
Section Cited
CCR
101216(g)(1)
Personnel Requirements
(1) Except as specified in (3) below, good physical health shall be verified by a health screening, including a test for tuberculosis, performed by or under the supervision of a physician not more than one year prior to or seven days after employment or licensure.

This requirement is not met as evidenced by:
Deficient Practice Statement
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LPAs observed 2 out of 2 staff files did not contain health screening. This poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/12/2023
Plan of Correction
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The director will submit verification of completed health screening for staff and ensure it is in the staff files.
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:Amanda Blesi
LICENSING EVALUATOR NAME:Arianna Manabat
LICENSING EVALUATOR SIGNATURE:
DATE: 08/29/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/29/2023


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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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: ADVENTURE MONTESSORI S.T.E.A.M ACADEMY LLC
FACILITY NUMBER: 343624323
VISIT DATE: 08/29/2023
NARRATIVE
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... Continued from LIC 809......

LPAs observed a current children's roster and fire drill; the last drill was conducted on 02/21/23. During this inspection, LPAs observed that the facility is equipped with First Aid equipment. Lastly, LPAs observed sign in app. During today’s visit, LPAs reviewed staff and children files. LPAs found that there were no infant staff files present at the facility.

LPAs discussed the safe sleep regulations with the Director and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPAs also informed the Director of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

This facility provides Incidental Medical Services – IMS. LPAs 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-care-centers/

Based on the inspection, Title 22 Deficiencies have been issued on the attached on the LIC 809-D page. The Licensee was informed that this report dated on 08/29/2023 documents one Type A citation which shall be posted for 30 consecutive days. The Licensee shall also provide a copy of this licensing report to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report.

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. A signed Acknowledgement of Receipt of the Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification. The facility has been provided with appeal rights.
SUPERVISORS NAME: Amanda Blesi
LICENSING EVALUATOR NAME: Arianna Manabat
LICENSING EVALUATOR SIGNATURE:

DATE: 08/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2023
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