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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376600627
Report Date: 10/08/2021
Date Signed: 10/08/2021 03:43:28 PM

Document Has Been Signed on 10/08/2021 03:43 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
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: 144TOTAL ENROLLED CHILDREN: 144CENSUS: 59DATE:
10/08/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:Anne PatzoldTIME COMPLETED:
03:49 PM
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Licensing Program Analyst (LPA), Tyra Block, conducted a Case Management- Incident inspection for the purpose of following up on a self-reported incident. LPA was greeted by Program Director, Paticia Smith, then met with Center Director, Anne Patzold. Present were 59 children and 12 staff (Penguins-8:2; Puffins-13:2; Manatee-9:2; Seals 10:2; Dolphins-6:2; amd Marlins-13:20.

Director provided requested documents including facility roster. LPA conducted an interview with Staff #1. Staff # 2 was not available.

An exit interview was conducted with Anne.

This report and appeal rights were provided. Signature provided to acknowledge receipt. A Notice of Site Visit was provided and must be posted for 30 consecutive days.
SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Tyra Block
LICENSING EVALUATOR SIGNATURE: DATE: 10/08/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/08/2021
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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