010214003-4-6-2023-52-CC-RHAR-CQMU88-20230406152107

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 010214003
Report Date: 04/06/2023
Date Signed: 04/06/2023 03:21:13 PM

Document Has Been Signed on 04/06/2023 03:21 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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME:	ADVENTURE TIME - MATTOS		FACILITY NUMBER:	010214003
ADMINISTRATOR:	PATRICIA SILVA		FACILITY TYPE:	840
ADDRESS:	37944 FARWELL DR		TELEPHONE:	(510) 713-2158
CITY:	FREMONT	STATE: CA	ZIP CODE:	94536
CAPACITY:	115	CENSUS: 42	DATE:	04/06/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:15 PM
MET WITH:	Patricia Silva		TIME COMPLETED:	03:30 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 April 06, 2022 at approximately 1:15pm, LPA Haderer arrived unannounced for an annual inspection for compliance to Health and Safety. Present for the inspection was the site director Patricia Silva, 5 teachers and 42 children in care (all school age). Adults present are background cleared and associated to this facility. The facility is in ratio today. Sign in/out sheets are done manually. All children present were signed in. Classrooms have trash cans with tight fitting cover for the disposal of solid waste. At this time the facility does not provide any incidental medical services such as inhalers or EpiPen’s to children in care. The facility is a single-story portable classroom on the campus of the Mattos Elementary school. There is an outdoor playground and large blacktop area. There are separate boys and girls bathrooms available in the building next to the playground area. Heating and ventilation is acceptable. All required posted documents were found to be in compliance and prominently posted in public places. LPA observed that all play equipment is in safe condition and free from sharp, loose or pointed parts and the areas around or under high climbing equipment has appropriate cushioned material that absorbs a fall. There is water available for the children and they also bring their own bottled water to school. Shade is available and teachers are always present when the children are outside. The facility has fully charged 3A40BC fire extinguisher next to the entry door, the last annual inspection was done 9/30/2022. Fremont Fire Department conducts fire inspections. The last inspection was completed in February 22, 2022 and all smoke detectors and the fire system are in good working order and passed inspection. Carbon monoxide detector was present, tested and functioning. The facility conducts monthly fire and/or earthquake drills, the last one completed was on 3-24-2023.

SUPERVISOR'S NAME: Chandra Charles	TELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Russell Haderer	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 04/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/06/2023

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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: ADVENTURE TIME - MATTOS	FACILITY NUMBER: 010214003
	VISIT DATE: 04/06/2023

NARRATIVE

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The facility is clean and well organized with ample age appropriate furnishings and equipment. Surfaces including floors and counter tops are clean and toxic free. Hazardous items/toxins are kept out of the access of children. There are no bodies of water accessible to children in care. The facility provides snacks for the children, snack menus were appropriately posted throughout the facility. All dry good and canned foods were checked and not expired.

Staff files were reviewed. All files were complete and in good order. Children's records were reviewed: LPA requested, and reviewed facility roster and a copy was taken for the office file. Children’s records were complete and in good order.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual – Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated 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

Site 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.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

There were no deficiencies cited during the inspection. This report will remain on file for 3 years.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the Site Director Patricia Silva.

SUPERVISOR'S NAME: Chandra Charles	TELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Russell Haderer	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 04/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/06/2023

LIC809 (FAS) - (06/04)

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