440702049-3-30-2023-07-CC-JMAS-CQESJP-20230330135528

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 440702049
Report Date: 03/30/2023
Date Signed: 03/30/2023 01:55:35 PM

Document Has Been Signed on 03/30/2023 01:55 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 PRE-SCHOOL		FACILITY NUMBER:	440702049
ADMINISTRATOR:	JAMES ERIC GROSS		FACILITY TYPE:	850
ADDRESS:	50 OCEAN STREET		TELEPHONE:	(831) 425-7002
CITY:	DAVENPORT	STATE: CA	ZIP CODE:	95017
CAPACITY:	24	CENSUS: 16	DATE:	03/30/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:25 AM
MET WITH:	Eric Gross		TIME COMPLETED:	02:10 PM

NARRATIVE

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Licensing Program Analysts (LPAs) Joe Macias and Jovani Dillon 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. LPAs met with the School Principal/ Director Eric Gross, and explained the nature of today's inspection. LPA toured the Facility both inside and outside during todays visit. LPA noted that the Facility is located on the Pacific Elementary School campus, in room #5. LPAs 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, 8:15am - 12:30pm. The LPAs observed that the facility is operating within the terms of the license and is in compliance with the approved fire clearance capacity.

The LPAs reviewed ten 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, physicians report, personal rights, and parents rights. All staff files contain the required transcripts/verification of experience. All staff's CPR and First Aid certifications are current. All staff have clearances through Pacific Elementary School District. Clearances for individuals at this facility who require caregiver background checks are issued by State Department and/or County Office of Education and do not come under the jurisdiction of Community Care Licensing Division. The Director understands that there shall be at least one person with valid CPR and First Aid certifications on site at all times, or present during off-site activities (field trips).

Director understands the conditions, limitations, and capacity specifications of the Facility license. Director understands that children shall be visually supervised at all times. LPAs 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 bottles, and cups. LPAs 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: 03/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2023

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: PACIFIC PRE-SCHOOL	FACILITY NUMBER: 440702049
	VISIT DATE: 03/30/2023

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LPAs observed all furniture and equipment is in good condition and safe for the children. The playground area utilized by children is surrounded by appropriate fencing. LPAs observed that the outdoor equipment is age appropriate. The LPAs did not observe any bodies of water.

The center has completed the facility lead testing, and supporting documents have been received. The center utilizes filtered drinking water. The food preparation and storage areas are clean, free of litter & rubbish, and free of rodents and other vermin. All food is provided by the Pacific Elementary School cafeteria. The LPAs observed an up to date and well balanced school menu.

Cleaning supplies are securely stored and inaccessible to the children. The last fire disaster drill was conducted on March 15, 2023.LPAs 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 (no daily medication).
This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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

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 the report was reviewed with the School Principal/ Director Eric Gross.

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: 03/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2023

LIC809 (FAS) - (06/04)

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