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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 274415464
Report Date: 03/02/2022
Date Signed: 03/02/2022 10:30:03 AM


Document Has Been Signed on 03/02/2022 10:30 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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131



FACILITY NAME:PACIFIC GROVE ADULT EDUCATION CDCFACILITY NUMBER:
274415464
ADMINISTRATOR:BARBARA MARTINEZFACILITY TYPE:
850
ADDRESS:1025 LIGHTHOUSE AVENUETELEPHONE:
(831) 646-6623
CITY:PACIFIC GROVESTATE: CAZIP CODE:
93950
CAPACITY:30CENSUS: 20DATE:
03/02/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
08:20 AM
MET WITH:Barbara MartinezTIME COMPLETED:
10:35 AM
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 February 28, 2022. LPA met with Program Director Barbara Martinez, and explained the nature of today's inspection to her. There were a total of 20 preschool age children at the facility today along with 4 fully qualified teachers, and 2 assistant teachers.

This case management inspection was made to inquire about an unusual incident that occurred on February 24, 2022.

During today's visit LPA Macias toured the facility both inside and outside, interviewed staff, reviewed facility files, and obtained copies of pertinent information. Based on staff interviews, as well as the self reported incident report; a child was left unsupervised in the laundry room for an unknown amount of time. Prior to today's inspection the director has held an all staff training focusing on safety and supervision. Ongoing professional development planned for staff to ensure supervision policy is understood and followed. A review of protocols for transitions both inside and outside the classroom.

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 Barbara Martinez.

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: Joel SeguraTELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Joseph MaciasTELEPHONE: (408) 334-8320
LICENSING EVALUATOR SIGNATURE:
DATE: 03/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/02/2022
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 03/02/2022 10:30 AM - 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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131


FACILITY NAME: PACIFIC GROVE ADULT EDUCATION CDC
FACILITY NUMBER: 274415464

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/02/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/04/2022
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 interviews, as well as the self reported incident report; a child was left unsupervised in the laundry room for an unknown amount of time.
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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: Joel SeguraTELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Joseph MaciasTELEPHONE: (408) 334-8320
LICENSING EVALUATOR SIGNATURE:
DATE: 03/02/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/02/2022
LIC809 (FAS) - (06/04)
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