015700540-7-12-2021-52-CC-MOTI-C4UUM8-20210712154156

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 015700540
Report Date: 07/12/2021
Date Signed: 07/12/2021 03:42:04 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 MONTESSORI ACADEMY		FACILITY NUMBER:	015700540
ADMINISTRATOR:	SINGH, ASHESH		FACILITY TYPE:	850
ADDRESS:	4101 PLEIADES PLACE		TELEPHONE:	(408) 464-3131
CITY:	UNION CITY	STATE: CA	ZIP CODE:	94587
CAPACITY:	60	CENSUS: 21	DATE:	07/12/2021
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	11:50 AM
MET WITH:	Ashesh Singh		TIME COMPLETED:	04:00 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	A Prelicensing inspection was conducted today 7/12/2021 by Licensing Program Analyst (LPA) Melanie Otsuji. LPA met with Applicant, Ashesh Singh and Director Elizabeth Brodowski. The applicant has submitted an application for a CHANGE in OWNERSHIP PRESCHOOL license for 60 preschool aged children. The program will operate from 7:30AM - 5:30PM, Monday through Friday, in 5 classrooms. Present during today's visit were 5 staff members and 21 preschool aged children. A health and safety inspection was conducted inside and outside and the measurements for preschool component are as follows: INDOORS: 2092.85 square feet = 60 children OUTDOORS: 4907.90 square feet = 65 children The center has obtained an approved fire inspection clearance from the Union City Fire Department on 6/29/2021 for a capacity of 60 preschool aged children. The preschool rooms are equipped with varied age appropriate materials and equipment. There are 6 toilets and 7 sinks available for children. Staff toilet is located in the Director's office. The facility has a kitchen and no cleaners or toxic materials were observed stored with food. Facility will provide AM/PM snacks with a menu posted for an authorized representative to see. Children will bring lunch from home. The Director's office and staff bathroom will serve as isolation areas for sick children. This facility plans to provide Individual Medical Services – IMS. A Plan of Operation that includes IMS must be submitted to the Department when any changes are made. 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.

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR NAME: Melanie Otsuji	TELEPHONE: (510) 622-2613
LICENSING EVALUATOR SIGNATURE:	DATE: 07/12/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2021

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 MONTESSORI ACADEMY	FACILITY NUMBER: 015700540
	VISIT DATE: 07/12/2021

NARRATIVE

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The play yards are fenced in all around. Building overhang and shade tarp provide sufficient shade in the play yard. Children bring water bottles from home and are refilled by the facility as needed for indoor and outdoor activities. There is a microwave and refrigerator available. First aid supplies are available in the center. There is a working telephone on site. Carbon monoxide detector is available and operable. Paper sign in/out is utilized and has enough space to record the date, time and full legal signature of the child's authorized representative.

Elizabeth Brodowski is a fully qualified preschool director and has completed 16 hours of health and safety training including pediatric CPR and First Aid.

Mandated reporter and appeal rights, civil penalties, unusual incident reporting and fingerprint requirements were discussed today. Licensee is also being informed of the web address (www.ccld.ca.gov) for downloading child care forms, and the director is encouraged to email ChildCareAdvocatesprogram@dss.ca.gov to be included in the Child Care Quarterly Updates distribution list. The director is also reminded that mandated reporter training is required for all staff and is to be renewed every 2 years at www.mandatedreporterca.com.

Zero Tolerance policies were explained. The center was found to be clean, safe, sanitary, and in good repair.

A license for 60 preschool aged children operating out of 5 classrooms (Kindergarten, Science Room, PreK Room, 3's Room and 2's Room) will be issued on today's date, 7/12/2021.

An exit interview was conducted.

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR NAME: Melanie Otsuji	TELEPHONE: (510) 622-2613
LICENSING EVALUATOR SIGNATURE:	DATE: 07/12/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2021

LIC809 (FAS) - (06/04)

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