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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 274410781
Report Date: 09/01/2022
Date Signed: 09/01/2022 03:36:36 PM


Document Has Been Signed on 09/01/2022 03:36 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:CSUMB CHILD DEVELOPMENT CENTERFACILITY NUMBER:
274410781
ADMINISTRATOR:JENNIFER SEBOLINOFACILITY TYPE:
850
ADDRESS:100 CAMPUS CENTER BLD #91TELEPHONE:
(831) 582-4550
CITY:SEASIDESTATE: CAZIP CODE:
93955
CAPACITY:36CENSUS: 22DATE:
09/01/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:25 PM
MET WITH:Jennifer SebolinoTIME COMPLETED:
03:50 PM
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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). LPA met with the Director Jennifer Sebolino, and explained the nature of today's inspection to her.

This inspection was made to inquire about an unusual incident that occurred on August 3, 2022. A child fell while playing outside, resulting in an injury. Staff observed the incident (fall), applied first aid, and immediately notified the child's parents. The child was picked up by this parent and taken to receive medical attention. LPA Macias reviewed the importance of maintaining constant supervision.

During today's inspection LPA Macias interviewed staff, toured the facility, reviewed facility files, and obtained copies of pertinent information.


No deficiency cited, exit interview conducted, and a copy of this report was reviewed with the Director Jennifer Sebolino.

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: 09/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/01/2022
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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