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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 274415464
Report Date: 01/24/2023
Date Signed: 01/24/2023 02:25:08 PM


Document Has Been Signed on 01/24/2023 02:25 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: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: 29DATE:
01/24/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:19 PM
MET WITH:Barbara MartinezTIME COMPLETED:
02:35 PM
NARRATIVE
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Licensing Program Analyst (LPA), Joe Macias, conducted an unannounced Case Management/ Incident Inspection. 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 Program Director Barbara Martinez, and explained the nature of today's visit. LPA toured the Facility both inside and outside during todays Inspection. There were a total of 29 children, and 6 staff members present during today's inspection.

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

During today's inspection LPA Macias reviewed the center's supervision policy. The LPA observed the procedures in action, and ensured that the LIC 9224 form was present in each child's file. The Director explained the procedures set in place to ensure supervision is maintained one hundred percent of the time. All new staff have been trained on the facility's supervision policy. LPA Macias reviewed the importance of maintaining visual supervision. No child(ren) shall be left without the supervision of a teacher at any time, supervision shall include 100% visual observation.

The facility has since utilized a daily routine tracker to ensure the supervision/ placement off all children in care. As well as constant head counts to assist in supervision during transitions.

No deficiencies cited, exit interview conducted, and a copy of this report was reviewed with the Program Director Barbara Martinez.

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

SUPERVISOR'S NAME: Gladys KuizonTELEPHONE: (510) 566-5850
LICENSING EVALUATOR NAME: Joseph MaciasTELEPHONE: (408) 334-8320
LICENSING EVALUATOR SIGNATURE:
DATE: 01/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/24/2023
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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