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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 270703733
Report Date: 09/28/2022
Date Signed: 09/28/2022 01:31:02 PM


Document Has Been Signed on 09/28/2022 01:31 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
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131



FACILITY NAME:MONTEREY PENINSULA COLLEGE CHILDREN'S CENTERFACILITY NUMBER:
270703733
ADMINISTRATOR:CATHERINE NYZNYKFACILITY TYPE:
850
ADDRESS:980 FREMONT STREETTELEPHONE:
(831) 646-4066
CITY:MONTEREYSTATE: CAZIP CODE:
93940
CAPACITY:96CENSUS: 55DATE:
09/28/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:13 AM
MET WITH:Jeff ProciveTIME COMPLETED:
01:35 PM
NARRATIVE
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Licensing Program Analyst (LPA), Joe Macias, conducted an unannounced case management inspection in response to an unusual incident that the facility self reported to Community Care Licensing (CCL) on September 22, 2022. LPA met with Program Director Jeff Procive, and explained the nature of today's inspection to him. There were a total of 55 preschool age children at the facility today along with 10 fully qualified teachers, and 2 student workers as this is a lab school.

This case management inspection was made to inquire about an unusual incident that occurred on September 15, 2022.

During today's visit LPA Macias toured the facility, interviewed staff, reviewed the LIC 624, and obtained copies of pertinent information. Based on staff interview, as well as the self reported incident report; a child was injured while outside on the playground, staff did not observe the incident. The Director conducts annual care and supervision training's, and will hold a review training in response to the unusual incident.

LPA Macias reviewed the importance of maintaining constant supervision. The facility shall provide care and supervision as necessary to meet the children's needs. No child shall be left without the supervision of a teacher at any time. Supervision shall include visual observation.

As a result of this inspection, a deficiency was cited.

Appeal right were printed and reviewed with the Director.

Type A deficiency cited, exit interview conducted, and a copy of this report was reviewed by the Director Jeff Procive.

A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE FRONT ENTRANCE TO THE CENTER, AND MUST REMAIN POSTED FOR 30 CONSECUTIVE DAYS.

SUPERVISOR'S NAME: Gladys KuizonTELEPHONE: (408) 314-5102
LICENSING EVALUATOR NAME: Joseph MaciasTELEPHONE: (408) 334-8320
LICENSING EVALUATOR SIGNATURE:
DATE: 09/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/28/2022
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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Document Has Been Signed on 09/28/2022 01:31 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131


FACILITY NAME: MONTEREY PENINSULA COLLEGE CHILDREN'S CENTER
FACILITY NUMBER: 270703733

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/28/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/14/2022
Section Cited

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Responsibility For Providing Care and Supervision - Title 22 regulations state a licensee shall provide care and supervision as necessary to meet the needs of each child, and no child shall be without supervision of a teacher at any time. This includes visual observation.
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Based on staff interview, as well as the self reported incident report; a child was injured while outside on the playground, staff did not observe the incident.
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AB 633 states upon receipt, licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months and it is to be signed and kept in each child’s file.

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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Gladys KuizonTELEPHONE: (408) 314-5102
LICENSING EVALUATOR NAME: Joseph MaciasTELEPHONE: (408) 334-8320
LICENSING EVALUATOR SIGNATURE:
DATE: 09/28/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/28/2022
LIC809 (FAS) - (06/04)
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