274415464-10-6-2020-07-CC-MMOO-BU5SKP-20201006135705

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 274415464
Report Date: 10/06/2020
Date Signed: 10/06/2020 01:57:22 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME:	PACIFIC GROVE ADULT EDUCATION CDC		FACILITY NUMBER:	274415464
ADMINISTRATOR:	BARBARA MARTINEZ		FACILITY TYPE:	850
ADDRESS:	1025 LIGHTHOUSE AVENUE		TELEPHONE:	(831) 646-6623
CITY:	PACIFIC GROVE	STATE: CA	ZIP CODE:	93950
CAPACITY:	30	CENSUS: 22	DATE:	10/06/2020
TYPE OF VISIT:	Case Management - Other	ANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Barbara Martinez		TIME COMPLETED:	02:00 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	On October 6, 2020 at 1:00 PM, Licensing Program Analyst (LPA), Marilou Monico, met Principal, Barbara Martinez, for an announced tele-inspection via Zoom Meeting. LPA advised Barbara that this Facility Evaluation Report (LIC 809) will be emailed to the facility. Facility’s reply to the email within 24 hours will serve as acknowledgement that the report was received. The purpose of the tele-inspection was to provide technical assistance in response to waiver request for 30 school age children to attend the facility due to the spread of COVID-19 in California. The facility is currently licensed for children ages 18 months to 4.11 years old in Rooms 17 and 18. Principal Barbara Martinez guided LPA on a tour of the facility via Zoom Meeting. The program operates Monday - Friday, from 07:00 a.m.- 6:00 p.m. Facility plans to have a station at the entryway of the main building for sign in/out and screening. The preschool and toddler option children have a station located in another building for sign in/out and screening. If child/ren become ill during the course of the day, they will be placed in an isolation area (Room 16). The school age children will be using the following classrooms: 8, 9, and 10. Each classroom will have a maximum of 14 children with 2 staff. The school age children have their own yard separate from the preschool and toddler option children. The yard is enclosed with fencing. Children will bring food for snacks and lunch from home. The program will ensure that children have access to drinking water at all times. Continuation on next page:

SUPERVISOR'S NAME: Anthony Studebaker	TELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Marilou Monico	TELEPHONE: (408) 334-8549
LICENSING EVALUATOR SIGNATURE:	DATE: 10/06/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2020

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

FACILITY NAME: PACIFIC GROVE ADULT EDUCATION CDC	FACILITY NUMBER: 274415464
	VISIT DATE: 10/06/2020

NARRATIVE

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Medication will not be administered at the facility.

The school age children will utilize the following restrooms which provide for individual privacy:
Room 8 - 1 toilet and 1 sink
Room 9 - 1 toilet and 1 sink
Restroom located next to Room 10 - 1 toilet and 1 sink

Hand washing and sanitizing stations are in place throughout the facility.

Community Care Licensing will provide on-going Technical Assistance (TA) to Pacific Grove Adult Education CDC.

Please feel free to contact the San Jose Child Care Regional Office at 408-324-2148.

Regional Manager: Carol Marcroft, telephone 408-324-2150
Licensing Program Manager: Sandy Knight, telephone 408-324-2151
Licensing Program Manager: Anthony Studebaker, telephone (408) 334-8553
Licensing Program Analyst: Marilou Monico, telephone 408-334-8549

SUPERVISOR'S NAME: Anthony Studebaker	TELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Marilou Monico	TELEPHONE: (408) 334-8549
LICENSING EVALUATOR SIGNATURE:	DATE: 10/06/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2020

LIC809 (FAS) - (06/04)

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