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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015700664
Report Date: 08/05/2025
Date Signed: 08/05/2025 12:45:26 PM

Document Has Been Signed on 08/05/2025 12:45 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 CC RO, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:ADVENTURE TIME EXTENDED DAYCAREFACILITY NUMBER:
015700664
ADMINISTRATOR/
DIRECTOR:		MIMI ALBERTFACILITY TYPE:
860
ADDRESS:45135 S. GRIMMER BLVDTELEPHONE:
(510) 806-5934
CITY:FREMONTSTATE: CAZIP CODE:
94539
CAPACITY: 115TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
08/05/2025
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:30 AM
MET WITH:Mimi AlbertTIME VISIT/
INSPECTION COMPLETED:
01:45 PM
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On 08/05/2025, Licensing Program Analyst (LPA) Brindha Govindasamy met with Jay Jay , Applicant representative and Mimi Albert, Director of Adventure Time Extended Day Care. The purpose of the visit was an announced pre-licensing inspection at the facility to ensure the health, safety and personal rights as required by Title 22 and Health and Safety Regulations governing California Child Care Centers will be met. Applicant is requesting a total of 115 school age children ages entry into TK to 12 years old. The childcare center will operate from Monday–Friday 7:00 AM to 6.00 PM. Fire clearance was approved on 09/26/2024.

Adventure Time Extended Day Care is requesting to operate in Multipurpose room, Room 27 and Room 28 on a functioning Fremont Unified Elementary school site (TK - 5th Grade), Fred E. Weibel Elementary School.



Indoor/Children's Area
All indoor and outdoor activity space utilized for the children was inspected today. LPA informed applicant that staff are required to maintain direct visual supervision of the children at all times during indoor and outdoor activities. The classrooms are observed to be clean, safe, sanitary and in good repair. All outdoor and indoor passageways and other areas of potential hazard were free of obstruction. A comfortable temperature for children shall be maintained at all times. Furniture and equipment were observed to be maintained in good condition, free of sharp, loose or pointed parts. All materials and surfaces accessible to children, including toys, shall be free of toxic substances. All play equipment and materials were observed to be age appropriate. Tables and chairs were observed to meet the needs of the children. There are sufficient chairs, tables, sinks, cubbies and toilets available for School age children.
NAME OF LICENSING PROGRAM MANAGER: Michael Duarte
NAME OF LICENSING PROGRAM ANALYST: Brindha Govindasamy
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 08/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/05/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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 CC RO, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: ADVENTURE TIME EXTENDED DAYCARE
FACILITY NUMBER: 015700664
VISIT DATE: 08/05/2025
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The Applicant shall take measures to keep the center free of flies, other insects, and rodents. All containers used for storage of solid waste, including moveable bins, shall have a tight fitting cover that is kept on. LPA observed no fireplace or open face heaters. Per director no fire arms at the facility. Facility will provide 2 snacks. LPA advised Applicant as per Title 22, if food is prepared off the center premises, the following shall apply: (A) The preparation source shall meet all applicable requirements for commercial food services.(B) The center shall have the equipment and staff necessary to receive and serve the food and to clean up.(C) The center shall maintain the equipment necessary for in-house food preparation, or shall have an alternate source for food preparation and service in the event of an emergency. Commercial foods shall be approved by appropriate federal, state and local authorities. All foods shall be selected, transported, stored, prepared and served so as to be free from contamination and spoilage and shall be fit for human consumption. LPA observed the facility has refrigerator and microwave in the premises.

Disinfectants, cleaning solutions, poisons and other items that could pose a danger if readily available to children shall be stored where inaccessible to children. Drinking water is readily available for the children in the facility via Colligan filtered water and water bottles.

Outdoor:

LPA observed that the facility has a fully fenced outdoor playground. Outdoor areas were free of hazards including holes, broken glass, dry grasses, and other debris that pose a fire hazard. LPA observed 02 separate outdoor play area for the younger and the older children. Any construction or equipment that could pose a hazard in the outdoor activity areas shall be made inaccessible to children in care. Shade was provided by awning and children will have to access to classrooms to cool off. There are sufficient outdoor age-appropriate toys and play equipment available on the playground. There is adequate cushioning in fall zones provided by tan bark. LPA observed no bodies of water. LPA informed that 100 % visual supervision is required during outdoor play time.


Drinking water from a non-contaminating fixture or container shall be readily available both indoors and in the outdoor activity area.

LPA advised per Health and Safety Code 1597.16(a)(1) Lead Testing and PIN-21-21-CCP Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010 to test their drinking water for lead contamination between January 1, 2020 and January 1, 2023, and then every 5 years after the date of the first test.

Per Written Directive 100700(c)(1) Written Directives for Lead Testing (1) For a license issued on or after July 1, 2022, initial testing results shall be received and posted within 180 days of licensure. Continue to page 3

NAME OF LICENSING PROGRAM MANAGER: Michael Duarte
NAME OF LICENSING PROGRAM ANALYST: Brindha Govindasamy
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2025
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 CC RO, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: ADVENTURE TIME EXTENDED DAYCARE
FACILITY NUMBER: 015700664
VISIT DATE: 08/05/2025
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This facility plan 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) or (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.

LPAs 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. LPAs also informed Applicants 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.

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

Applicant were informed of the MyChildCarePlan.org site, a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

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 platforms. 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.

Since this School Age Program operates on a functioning school site, pursuant to Health and Safety Code Section 1596.806 the Program is exempt from requirements for square-footage of indoor and outdoor activity space, toilet, fencing, and isolation space for child day care centers, pursuant to Health and Safety Code Section 1596.806.



Based on today's inspection, LPA determined that the facility's physical plant is in compliance with applicable Health & Safety Codes and Title 22 Regulations. A School Age License shall be issued for Adventure Time Extended Day Care to operate in Multipurpose room , Room 27 and Room 28 upon review by the Licensing Program Manager.

An exit interview was conducted, and a copy of appeal rights and this report was provided to director Mimi Albert.
NAME OF LICENSING PROGRAM MANAGER: Michael Duarte
NAME OF LICENSING PROGRAM ANALYST: Brindha Govindasamy
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2025
LIC809 (FAS) - (06/04)
Page: 4 of 4