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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343624324
Report Date: 07/28/2022
Date Signed: 07/28/2022 06:41:25 PM

Document Has Been Signed on 07/28/2022 06:41 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, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME:ADVENTURE MONTESSORI S.T.E.A.M ACADEMY LLCFACILITY NUMBER:
343624324
ADMINISTRATOR:SITHUMINI S MILLAWABANDARAFACILITY TYPE:
850
ADDRESS:3541 N FREEWAY BLVD SUITE 100TELEPHONE:
(916) 370-6113
CITY:SACRAMENTOSTATE: CAZIP CODE:
95835
CAPACITY: 37TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
07/28/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Sithumini MillawabandaraTIME COMPLETED:
04:00 PM
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Application Specialist (AS) Alecia Sifuentes met with Applicant, Sithumini (Situ) Millawabandara for the purpose of an announced pre-licensing inspection. Applicant requests a preschool license to serve 37 preschool children from age two to entry into kindergarten. The program will operate Monday through Friday from 7:00 a.m. to 6:00 p.m. The fire clearance was granted and received on 7/27/2022. The facility will provide breakfast, lunch, and afternoon snacks.

AS reviewed with applicant the LIC 311A, Records To Be Maintained At The Facility, for child’s records, personnel records, administrative records, and documents to be posted.

INDOOR ACTIVITY SPACE:
There is one preschool classroom. AS observed a sufficient amount of equipment, toys, tables, chairs, cubbies, and napping cots. AS did not observe enough chairs, cubbies, and nap cot. Applicant stated that more have been ordered and will be arriving by August 1st. There is a first aid kit located in the kitchen. Medications will be stored in the kitchen cabinet. AS observed cleaning disinfectants are appropriately stored and inaccessible to children. Applicant stated there are no poisons or firearms on the premises. AS observed a water pitcher in the classrooms. AS observed a functional carbon monoxide detector in the classroom. AS observed a sign-in/sign-out binder.

AS measured one classroom. The total classroom space contains a total of 1,259.78 square feet, which will only accommodate 35 preschool children. There are 3 toilets and 4 sinks for the children, and a separate private restroom for the staff. Individual measurements are recorded on the Capacity Worksheet (LIC 9024). Children who become ill during the day will be isolated in the front of the classroom in the library area, if necessary.

Report continues on LIC809-C.
SUPERVISORS NAME: Jeanne Smith
LICENSING EVALUATOR NAME: Alecia Sifuentes
LICENSING EVALUATOR SIGNATURE: DATE: 07/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/28/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME: ADVENTURE MONTESSORI S.T.E.A.M ACADEMY LLC
FACILITY NUMBER: 343624324
VISIT DATE: 07/28/2022
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OUTDOOR ACTIVITY SPACE:
There is one outdoor area on the property. The outdoor play area is fenced with a wrought iron fence that is at least four feet tall. Applicant has requested a Shared Outdoor Space Waiver. Applicant understands that the preschool children and infant children cannot commingle. AS observed a sufficient amount of equipment and toys. There is no play structure, only a portable slide and house. There are no bodies of water on the premises. There are shaded areas supplied by an overhang and one umbrella. Applicant stated they will be installing a retractable canopy.

AS measured the outdoor activity space. The outdoor play area contains a total of 2,987.59 square feet, which will accommodate 35 preschool children. Individual measurements are recorded on the Capacity Worksheet (LIC 9024).

This facility plans to provide Incidental Medical Services – IMS. For IMS information, see PIN 22-02-CCP. A 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)/ (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

AS discussed the following: 100% supervision is required at all times, including in the bathroom; personal rights; inspection authority; reporting requirements; staff to children ratios and capacity; staff qualifications; and maintaining buildings and grounds. AS discussed with Applicant any changes that may occur regarding the director or an employee acting in the director's absence must be reported to department within 10 working days.

Applicant was reminded that all adults 18 and over responsible for administration or direct supervision of staff, persons who provides care and supervision to children, and staff who have contact with children, 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.

Report continues on LIC809-C.
SUPERVISORS NAME: Jeanne Smith
LICENSING EVALUATOR NAME: Alecia Sifuentes
LICENSING EVALUATOR SIGNATURE:

DATE: 07/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2022
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, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME: ADVENTURE MONTESSORI S.T.E.A.M ACADEMY LLC
FACILITY NUMBER: 343624324
VISIT DATE: 07/28/2022
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Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform. To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

Exit interview conducted and report was reviewed with the applicant, Sithumini Millawabandara.

The following items are required before a license will be issued:
1. Updated LIC200A
2. Updated granted fire clearance (STD850)
3. Remaining paperwork
4. Final file review from Licensing Program Manager
SUPERVISORS NAME: Jeanne Smith
LICENSING EVALUATOR NAME: Alecia Sifuentes
LICENSING EVALUATOR SIGNATURE:

DATE: 07/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2022
LIC809 (FAS) - (06/04)
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