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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013412462
Report Date: 06/22/2023
Date Signed: 06/22/2023 09:17:26 AM


Document Has Been Signed on 06/22/2023 09:17 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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612



FACILITY NAME:ADVENTURE TIME - GLENMOORFACILITY NUMBER:
013412462
ADMINISTRATOR:PITRUZZELLO, HEATHERFACILITY TYPE:
840
ADDRESS:4620 MATTOS DRIVETELEPHONE:
(510) 744-0772
CITY:FREMONTSTATE: CAZIP CODE:
94536
CAPACITY:60CENSUS: 0DATE:
06/22/2023
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Mimi AlbertTIME COMPLETED:
08:45 AM
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On June 22, 2023 at approximately 8:00am Licensing Program Manager (LPA) Haderer met with Program Director Mimi Albert for a site inspection to re-activate the center license. The school is closed for the summer and will reopen August 14, 2023.

An inspection was completed for health and safety to ensure the facility meets requirements.

The site has 2 fully charged 3A40BC fire extinguishers, last serviced 7-27-2022. There is a working and tested carbon monoxide detector, smoke alarms were tested by the Fremont Fire department on 11-27-2022 and passed inspection. Fire/disaster drill log was present showing that disaster drills are completed at least once every 6 months, the last drill was completed on 5-10-2023. Playground area was checked for safely and complies with Title 22 requirements.

Center Director's paperwork was checked, Mandated Reporter certificate was completed on 9-26-2021, CPR/1st aid certificate is current and expires on 2-15-2024.

All required documents to be posted were present: License; Emergency Disaster Plan; Earthquake Preparedness: Seat Belt laws; Parent's Rights; and Personal Rights.

The center is in compliance and the license will be changed to Active Status as of this day 6-22-2023.

There were no deficiencies found during today's inspection.

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

Exit interview conducted and report was reviewed with the Program Director Mimi Albert.
SUPERVISOR'S NAME: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Russell HadererTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:
DATE: 06/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/22/2023
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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