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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343624323
Report Date: 10/02/2024
Date Signed: 10/02/2024 12:09:31 PM

Document Has Been Signed on 10/02/2024 12:09 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/
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: 4DATE:
10/02/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:35 AM
MET WITH:Sithumini MillawabandaraTIME VISIT/
INSPECTION COMPLETED:
12:30 PM
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Licensing Program Analysts (LPAs) Mandie Goodwin and Kyrsten Williams met with Licensee, Sithumini Millawabandara, for the purpose of an unannounced plan of correction inspection. Census included 4 infants supervised by one staff member.

On September 17th, 2024, licensee was issued one type B citation due to not having Needs and Service Plans for infants in care. To correct the deficiency LPAs returned to review files. Facility provided each family in the infant room with a Needs and Service Plan to complete and update every 3 months or as needed. LPAs reviewed one file which was observed to be complete. Deficiency was cleared and a letter was provided.

Report was reviewed with Licensee Sithumini Millawabandara and exit interview was conducted. A notice of site visit was given and must remain posted for 30 days. No deficiencies were observed during inspection.
SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Mandie Goodwin
LICENSING EVALUATOR SIGNATURE: DATE: 10/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/02/2024
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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