010212693-9-10-2021-52-CC-JWIS-C6QRQA-20210910131312

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 010212693
Report Date: 09/10/2021
Date Signed: 09/10/2021 01:13:49 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME:	ADVENTURE TIME - INDEPENDENT		FACILITY NUMBER:	010212693
ADMINISTRATOR:	BREWER, TAMMY		FACILITY TYPE:	840
ADDRESS:	21201 INDEPENDENT SCHOOL ROAD		TELEPHONE:	(510) 733-9134
CITY:	CASTRO VALLEY	STATE: CA	ZIP CODE:	94552
CAPACITY:	150	CENSUS: 7	DATE:	09/10/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Mimi Albert		TIME COMPLETED:	01:23 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 09/10/2021 at 09:15am, Licensing Program Analyst (LPA) Jonathan Williams met with Mimi Albert (Director for all Adventure Time facilities) for a Required 1-Year Inspection. Present for this inspection are Mimi Albert, 3 fingerprint cleared and associated staff members, and 7 children in care. Facility operating hours are 7am-6:00pm M-F. The facility was toured to conduct a Health and Safety Inspection. At 10:45am, LPA toured the facility classrooms. The facility operates in two portables on the site of Independent Elementary School. The classrooms are tidy and clean with heating and ventilation for safety and comfort. There are safe age-appropriate toys and learning materials available to children throughout the classrooms. All hazardous materials and toxins including disinfectants and cleaning solutions were observed to be made inaccessible to children during today's inspection. Furniture accessible to children was observed to be age-appropriate, in operable condition, and free of loose, sharp, or pointed parts. Snack food is protected from contamination and, per staff, contaminated food is discarded immediately. Food/beverages capable of rapid spoiling are properly stored. Uncontaminated drinking water is available to children inside and outside the facility. At 11:15am, LPA toured the outdoor play area. All play equipment was observed to be operable and age-appropriate during this inspection. Areas around swings, slides, and high climbing equipment have cushioning material to absorb falls. Uncontaminated drinking water is available to children in the outdoor area. There are no pools, hot tubs, ponds, or any other bodies of water accessible to children during today's inspection. At 11:55am, LPA toured the facility bathroom. LPA observed adequate amounts of paper towels and hand soap available to children in the bathroom during today's inspection. No cleaning supplies were observed to be accessible to children during today's inspection.

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR NAME: Jonathan Williams	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 09/10/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2021

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: ADVENTURE TIME - INDEPENDENT	FACILITY NUMBER: 010212693
	VISIT DATE: 09/10/2021

NARRATIVE

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At 12:10pm, LPA reviewed sign in/sign out sheet. LPA observed seven (7) signatures out of seven (7) children present in the facility during today's inspection.

The facility has four fully charged 3A40BC fire extinguishers (two in each classroom), working smoke detectors, working carbon monoxide detectors, and working telephone. At least one staff member has current CPR/1st Aid certificate. The facility is in ratio today. Children's files and staff files were reviewed for proper documentation. All required forms are posted in public view, including menus. Facility roster was obtained.

Incidental Medical Services (IMS) policy was discussed. This facility provides IMS to children in care. Facility is following IMS plan on file. When any changes to the IMS plan is made, an updated Plan for Providing 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.”

Director was reminded that all adults 18 and over, 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.

Director was reminded that California Law requires licensed Child Care Centers to report unusual incidents or injuries to children in care to child's parents and to the Department of Social Services using the Unusual Incident/Injury form (LIC 624). Incidents must be reported within 24 hours by phone, fax, or electronic mail. LPA informed the Director that all forms can be downloaded at www.ccld.ca.gov and encouraged the Director to email childcareadvocatesprogram@dss.ca.gov to be included in the Child Care Quarterly Updates distribution list. The Director was also reminded that Mandated Reporter Training ("General" and "Child Care Providers") is required for all staff and is to be renewed every 2 years by visiting www.mandatedreporterca.com.

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR NAME: Jonathan Williams	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 09/10/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2021

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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: ADVENTURE TIME - INDEPENDENT	FACILITY NUMBER: 010212693
	VISIT DATE: 09/10/2021

NARRATIVE

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LPA discussed the safe sleep regulations with 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. LPA also informed 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.

There are no deficiencies cited. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Director. Appeal rights were provided to the Director and the signature on this form acknowledges receipt of these rights.

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR NAME: Jonathan Williams	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 09/10/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2021

LIC809 (FAS) - (06/04)

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