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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376600627
Report Date: 11/30/2022
Date Signed: 11/30/2022 11:12:30 AM


Document Has Been Signed on 11/30/2022 11:12 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, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108



FACILITY NAME:JEFF & DENI JACOBS CHILD DEVELOPMENT CENTERFACILITY NUMBER:
376600627
ADMINISTRATOR:ANNE PATZOLDFACILITY TYPE:
850
ADDRESS:2360 EAST JEWETT STREETTELEPHONE:
(858) 278-2571
CITY:SAN DIEGOSTATE: CAZIP CODE:
92111
CAPACITY:144CENSUS: 74DATE:
11/30/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:05 AM
MET WITH:Anne PatzoldTIME COMPLETED:
11:25 AM
NARRATIVE
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On 11/30/2022 @ 10:05AM, LPA Nancy Diaz conducted an unannounced case management inspection in reference to a self-reported incident that occurred on 11/14/2022 @ approximately 10:17AM when students in the Puffins room were transitioning from the outdoor to their indoor classroom. Two children were found in the enclosed playground by another staff without adult supervision. Ms. Patzold stated that the two children were without adult supervision for approximately 13 minutes. Staff in charge of the children were in the process of conducting a name-to-face (inside the building) when the 2 children were brought in from the playground by another staff. Staff were immediately terminated for not following procedures.

A tour of the center was conducted with Ms. Patzold. Observed present today were 74 children in the following classrooms:
9 - 2.y.o. children in the Penguins room with staff Alejandra Armenta, Nayra Chavez and Deelia Martinez
17 - 3 y.o. children in the Puffins room with staff Marissa Pacheco, Amanda Loiurio and Jocelyn Rios-Paco
12 - 4 y.o. children in the Seals room with staff Meredith Cruz, Alexis Crea and Jocelyn Rangel
15 - 3 y.o. children in the Manatees room with staff Alexa Alvarez & Denise Reyes
10 - 4 y.o. children in the Dolphins room with staff Stephanie Figueroa, Rosa Mejia & Lourdes Aguilar
11 - 4 y.o. children in the Marlins room with staff Stephanie Villareal & Alexa Martinez.
Type B deficiency was cited today. Civil Penalty was assessed for repeat violation. Type B deficiency if not corrected possess a potential risk to the health, safety or personal rights of children in care.
Exit interview was conducted with Anne Patzold. A copy of this report and appeal rights were provided today. Notice of site visit was provided and observed posted today. This notice shall remain posted for 30 days.
SUPERVISOR'S NAME: Tashima DanielTELEPHONE: (619) 767-2242
LICENSING EVALUATOR NAME: Nancy DiazTELEPHONE: (619) 767-2207
LICENSING EVALUATOR SIGNATURE:
DATE: 11/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/30/2022
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 11/30/2022 11:12 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, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108


FACILITY NAME: JEFF & DENI JACOBS CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 376600627

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/30/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/30/2022
Section Cited

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Care and Supervision
No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation.
This regulation was not met as evidenced by:
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Based on the self-reported incident report and interview with Site Director Anne Patzold, 2 preschool children were left behind the enclosed playground without adult supervision for approximately 13 minutes. This is a repeat violation.
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Ms. Patzold shall submit a copy of the agenda and a sign-in sheet via email no later than 12/1/2022. Email address is: Nancy.diaz@dss.ca.gov

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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: Tashima DanielTELEPHONE: (619) 767-2242
LICENSING EVALUATOR NAME: Nancy DiazTELEPHONE: (619) 767-2207
LICENSING EVALUATOR SIGNATURE:
DATE: 11/30/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/30/2022
LIC809 (FAS) - (06/04)
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