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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343624323
Report Date: 07/11/2024
Date Signed: 11/06/2024 10:55:26 AM

Document Has Been Signed on 11/06/2024 10:55 AM - 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/
DIRECTOR:		ROBERTA MANLEYFACILITY TYPE:
830
ADDRESS:3541 N FREEWAY BLVD SUITE 100TELEPHONE:
(916) 370-6113
CITY:SACRAMENTOSTATE: CAZIP CODE:
95834
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 6DATE:
07/11/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:20 AM
MET WITH:Sithumini MillawabandaraTIME VISIT/
INSPECTION COMPLETED:
03:00 PM
NARRATIVE
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This is an amended version of the original report created on 7/11/24.
SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Mandie Goodwin
LICENSING EVALUATOR SIGNATURE: DATE: 11/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/06/2024
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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Document Has Been Signed on 07/11/2024 02:34 PM - It Cannot Be Edited


Created By: Mandie Goodwin On 07/11/2024 at 12:31 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: 07/11/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Deficiency Dismissed
Type A
07/12/2024
Section Cited
CCR
101416.5(b)

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Staff-Infant Ratio:
There shall be a ratio of one teacher for every four infants in attendance.

This Requirement is not met as evidenced by:
Based on observation and interview there was one staff member in the infant room
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Director stated that they were short staffed that day and it took a while to call an additional staff member in.
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with 6 children, which poses an immediate health, safety, or personal rights risk to pesons in care.
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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:Seychelle De Luca
LICENSING EVALUATOR NAME:Mandie Goodwin
LICENSING EVALUATOR SIGNATURE:
DATE: 07/11/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/11/2024


LIC809 (FAS) - (06/04)
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