274410782-1-18-2023-07-CC-JMAS-CN7RDN-20230118115612

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 274410782
Report Date: 01/18/2023
Date Signed: 01/18/2023 11:56:19 AM

Document Has Been Signed on 01/18/2023 11:56 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
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME:	CSUMB CHILD DEVELOPMENT CENTER		FACILITY NUMBER:	274410782
ADMINISTRATOR:	JENNIFER SEBOLINO		FACILITY TYPE:	830
ADDRESS:	100 CAMPUS CENTER BLD. #91		TELEPHONE:	(831) 582-4550
CITY:	SEASIDE	STATE: CA	ZIP CODE:	93955
CAPACITY:	12	CENSUS: 4	DATE:	01/18/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:11 AM
MET WITH:	Jennifer Sebolino		TIME COMPLETED:	12:15 PM

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Licensing Program Analyst (LPA) Joe Macias conducted an unannounced Required - 1 Year Inspection (care tool). The purpose of today’s visit is to ensure the facility is in compliance with Title 22 California Code of Regulations. LPA met with the Director Jennifer Sebolino, and explained the nature of today's visit. The facility also has a preschool license #274410781 on site. LPA toured the Facility both inside and outside during todays visit. LPA observed the required posted materials, including the Facility License, Emergency Disaster Plan (LIC 610), Earthquake Preparedness Checklist (LIC 9148), Parents' Rights Poster (PUB 393), Personal Rights (LIC 613A), Child Car Seat Law (PUB 269), and Activity Schedule. The hours of operation are Monday - Friday, 7am - 5:30pm. The center has an active waiver to allow the Infant program to share the space used by the preschool children between 7:00 a.m. to 8:00 a.m. and 4:30 p.m. to 5:30 p.m.

LPA reviewed four children's and three staff files during today's visit. Each child's file reviewed contains the Information and Emergency Information form (LIC 700), immunization records, LIC 9227, physicians report, personal rights, and parents rights, as well as Needs & Services Plans. Needs & Services Plans also include individual feeding plans for each child and are updated at least once every three months or sooner if needed. The Site Directors file contain the required transcripts/verification of experience. Director and all staff have current CPR and First Aid certifications on file. The Director understands that there shall be at least one person, with valid CPR and First Aid certifications, on site at all times in each licensed program (infant/ preschool) or present during off-site activities (field trips).

Director understands the conditions, limitations, and capacity specifications of the Facility license. Director understands that infants shall be visually supervised at all times. LPA observed that all rooms are in order. Drinking water is readily available for the children in each room and in the outdoor playground area via water dispensers, water bottles, and cups. LPA observed solid waste containers with tight-fitting lids in each room. Staff and children's bathrooms are clean, sanitary. There is a separate staff bathroom not utilized by the children which an isolated child can use if needed. Director states that there are no weapons or firearms on the premises.

SUPERVISOR'S NAME: Gladys Kuizon	TELEPHONE: (510) 566-5850
LICENSING EVALUATOR NAME: Joseph Macias	TELEPHONE: (408) 334-8320
LICENSING EVALUATOR SIGNATURE:	DATE: 01/18/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/18/2023

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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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: CSUMB CHILD DEVELOPMENT CENTER	FACILITY NUMBER: 274410782
	VISIT DATE: 01/18/2023

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LPA observed all furniture and equipment is in good condition and safe for the children. The infant changing table has raised sides that are at least 3 inches in height. The infant changing table(s) has a vinyl changing pad that is at least 1 inch think and in good condition. Napping equipment is appropriate. The playground area utilized by children is surrounded by appropriate fencing. The infant playground/ outdoor space is separate from the preschool outdoor space. LPA observed that the outdoor equipment is age appropriate. LPA did not observe any bodies of water.

LPA also went over safe sleep for infants.

The food preparation and storage areas are clean, free of litter & rubbish, and free of rodents and other vermin. Cleaning supplies are securely stored and inaccessible to the children. LPA observed a fully charged 2A10BC fire extinguisher, and working smoke/carbon monoxide detectors. Director states that the Facility does not administer medications at this time.

The Director Jennifer Sebolino was reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated 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)/ (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: Gladys Kuizon	TELEPHONE: (510) 566-5850
LICENSING EVALUATOR NAME: Joseph Macias	TELEPHONE: (408) 334-8320
LICENSING EVALUATOR SIGNATURE:	DATE: 01/18/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/18/2023

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
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: CSUMB CHILD DEVELOPMENT CENTER	FACILITY NUMBER: 274410782
	VISIT DATE: 01/18/2023

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To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

No deficiencies cited, exit interview conducted and report was reviewed with the Director Jennifer Sebolino.

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

SUPERVISOR'S NAME: Gladys Kuizon	TELEPHONE: (510) 566-5850
LICENSING EVALUATOR NAME: Joseph Macias	TELEPHONE: (408) 334-8320
LICENSING EVALUATOR SIGNATURE:	DATE: 01/18/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/18/2023

LIC809 (FAS) - (06/04)

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